Provider Demographics
NPI:1568882652
Name:BERLIN, KIMBERLY MAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MAE
Last Name:BERLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6066 STATE ROUTE 434
Mailing Address - Street 2:APT D-1
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-2444
Mailing Address - Country:US
Mailing Address - Phone:607-372-1687
Mailing Address - Fax:
Practice Address - Street 1:6066 STATE ROUTE 434
Practice Address - Street 2:APT D-1
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-2444
Practice Address - Country:US
Practice Address - Phone:607-372-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303826-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse