Provider Demographics
NPI:1154053387
Name:BERMAN, LUCY NICOLE (MPH, RD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:NICOLE
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 16TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2411
Mailing Address - Country:US
Mailing Address - Phone:954-649-8050
Mailing Address - Fax:
Practice Address - Street 1:1111 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2411
Practice Address - Country:US
Practice Address - Phone:954-649-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4451133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered