Provider Demographics
NPI:1417742917
Name:BERNARD, ANNIE J
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:J
Last Name:BERNARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3261
Mailing Address - Country:US
Mailing Address - Phone:330-853-9520
Mailing Address - Fax:330-853-9520
Practice Address - Street 1:658 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3261
Practice Address - Country:US
Practice Address - Phone:330-853-9520
Practice Address - Fax:330-853-9520
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist