Provider Demographics
NPI:1902088925
Name:BERNARD, EMILY DIANE (MA, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DIANE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ALPINE DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-383-1606
Mailing Address - Fax:209-722-8064
Practice Address - Street 1:50 ALPINE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-383-1606
Practice Address - Fax:209-722-8064
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No174N00000XOther Service ProvidersLactation Consultant, Non-RN