Provider Demographics
NPI:1619271806
Name:BEREBITSKY, URSULA DIKSHA
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:DIKSHA
Last Name:BEREBITSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 DONNELLY DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4997
Mailing Address - Country:US
Mailing Address - Phone:360-455-4566
Mailing Address - Fax:
Practice Address - Street 1:3344 DONNELLY DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4997
Practice Address - Country:US
Practice Address - Phone:360-455-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula