Provider Demographics
NPI:1508068180
Name:BERNER, ABIGAIL USEN (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:USEN
Last Name:BERNER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:KATHERINE
Other - Last Name:USEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD,LDN
Mailing Address - Street 1:26 WAMPUM DR
Mailing Address - Street 2:P.O BOX 1709
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1956
Mailing Address - Country:US
Mailing Address - Phone:508-896-9080
Mailing Address - Fax:
Practice Address - Street 1:26 WAMPUM DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1956
Practice Address - Country:US
Practice Address - Phone:508-896-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002556001OtherMEDICARE PTAN