Provider Demographics
NPI:1245366657
Name:BERNARD, ELLEN ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 GREYSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2939
Mailing Address - Country:US
Mailing Address - Phone:440-717-1727
Mailing Address - Fax:440-746-0675
Practice Address - Street 1:9531 GREYSTONE PKWY
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2939
Practice Address - Country:US
Practice Address - Phone:440-717-1727
Practice Address - Fax:440-746-0675
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN277052163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2699932Medicaid