Provider Demographics
NPI:1053577940
Name:FERNANDES, BERNARD ANTONY (CRNA)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:ANTONY
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:HC-71
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-3290
Mailing Address - Fax:504-988-6216
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:HC-71
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-3290
Practice Address - Fax:504-988-6216
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05548367H00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309672Medicaid
AL1053577940Medicaid
MS09008854Medicaid
LA3A771CQ68Medicare PIN