Provider Demographics
NPI:1558805184
Name:BERLT, MARLENE E (RN)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:E
Last Name:BERLT
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:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:NY
Mailing Address - Zip Code:12451-0412
Mailing Address - Country:US
Mailing Address - Phone:518-965-2580
Mailing Address - Fax:
Practice Address - Street 1:#1054 RT. 23B
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:NY
Practice Address - Zip Code:12451
Practice Address - Country:US
Practice Address - Phone:518-965-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556943-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health