Provider Demographics
NPI:1659851046
Name:BERLOWE, MICHAEL (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BERLOWE
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5452
Mailing Address - Country:US
Mailing Address - Phone:928-910-9512
Mailing Address - Fax:
Practice Address - Street 1:306 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2634
Practice Address - Country:US
Practice Address - Phone:928-775-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily