Provider Demographics
NPI:1265474407
Name:BERMANN, PAULA EDITH (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:EDITH
Last Name:BERMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2225
Mailing Address - Country:US
Mailing Address - Phone:912-234-6779
Mailing Address - Fax:912-234-6779
Practice Address - Street 1:303 E 48TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2225
Practice Address - Country:US
Practice Address - Phone:912-234-6779
Practice Address - Fax:912-234-6779
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2594363LF0000X
GARN 109098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP388296745Medicare PIN
SCP288294065Medicare PIN
SCP388294053Medicare PIN
P38829Medicare UPIN