Provider Demographics
NPI:1861562498
Name:BERNARD, KAREN MARIE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92049-0516
Mailing Address - Country:US
Mailing Address - Phone:760-519-6632
Mailing Address - Fax:973-924-1457
Practice Address - Street 1:27871 MEDICAL CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6406
Practice Address - Country:US
Practice Address - Phone:760-519-6632
Practice Address - Fax:973-924-1457
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409982163W00000X
CA1876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC780ZOtherMEDICARE PTAN