Individual
JESSICA LASAK BERNARDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1222
(630) 933-2157
(630) 933-4936
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1222
(630) 933-2157
(630) 933-4936
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209011971
IL
363LP0200X
Pediatric Nurse Practitioner
209011971
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400172928
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
10/20/2014
Last updated
11/12/2019
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