Provider Demographics
NPI:1164018529
Name:BERFT, VIVIEN A
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:A
Last Name:BERFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 DUCKBILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2716
Mailing Address - Country:US
Mailing Address - Phone:804-878-0768
Mailing Address - Fax:
Practice Address - Street 1:11900 DUCKBILL DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2716
Practice Address - Country:US
Practice Address - Phone:804-878-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program