Provider Demographics
NPI:1558760017
Name:BERKLAND, ELISE SUZANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:SUZANNE
Last Name:BERKLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:SUZANNE
Other - Last Name:EDGERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:106 RIDGE VIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6647
Mailing Address - Country:US
Mailing Address - Phone:919-319-6363
Mailing Address - Fax:919-319-1331
Practice Address - Street 1:106 RIDGE VIEW DR STE A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6647
Practice Address - Country:US
Practice Address - Phone:919-319-6363
Practice Address - Fax:919-319-1331
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily