Basic Information
| Provider Information | |||||||||
| NPI: | 1710487921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNING | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6060 N COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462201907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175845166 | ||||||||
| FaxNumber: | 3178153861 | ||||||||
| Practice Location | |||||||||
| Address1: | 3948 NEW VISION DR STE D | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2602451455 | ||||||||
| FaxNumber: | 3178153861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.