Provider Demographics
NPI:1922003524
Name:PRICE, BERNADETTE K (CNM)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:K
Last Name:PRICE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4284
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:297 W FRANCISCAN DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4858
Practice Address - Country:US
Practice Address - Phone:219-662-6151
Practice Address - Fax:219-662-6156
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000074A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200314080Medicaid
IN000000722777OtherANTHEM TRADITIONAL
IN000000722777OtherANTHEM TRADITIONAL
IN200314080Medicaid
INM400049267Medicare PIN