Provider Demographics
NPI:1013586502
Name:BERLETT, CHRISTINA (RN IBCLC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:BERLETT
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KEIL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9113
Mailing Address - Country:US
Mailing Address - Phone:443-604-1449
Mailing Address - Fax:
Practice Address - Street 1:2 KEIL MANOR CT
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:MD
Practice Address - Zip Code:21161-9113
Practice Address - Country:US
Practice Address - Phone:443-604-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167672163W00000X, 163WL0100X
MDL-137272174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR167672OtherRN