Provider Demographics
NPI:1538500574
Name:BEROSKE, MARCIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:
Last Name:BEROSKE
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 1:1670 UPHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1250
Mailing Address - Country:US
Mailing Address - Phone:614-293-9600
Mailing Address - Fax:
Practice Address - Street 1:1670 UPHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1250
Practice Address - Country:US
Practice Address - Phone:614-293-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15448-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28210549AOtherSTATE OF INDIANA, REGISTERED NURSE
IN71004484BOtherSTATE OF INDIANA CSR, PRESCRIPTIVE AUTHORITY
OHRN.312282-COA1OtherREGISTERED NURSE CERTIFICATE OF AUTHORITY
OHCOA.15448-NPOtherCERTIFIED NURSE PRACTITIONER
OHRX.15448-EX1OtherPRESCRIPTIVE AUTHORITY-EXTERNSHIP
2013010755OtherANCC ID NUMBER
IN71004484AOtherSTATE OF INDIANA, APN, PRESCRIPTIVE AUTHORITY