Provider Demographics
NPI:1467689711
Name:DASQUE, BERTHY (RN)
Entity Type:Individual
Prefix:MRS
First Name:BERTHY
Middle Name:
Last Name:DASQUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 DOUGLAS PL
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1465
Mailing Address - Country:US
Mailing Address - Phone:718-276-4209
Mailing Address - Fax:
Practice Address - Street 1:2245 CURZON WAY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1744
Practice Address - Country:US
Practice Address - Phone:718-276-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY358605-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse