Provider Demographics
NPI:1679549778
Name:BERARD, LISA F (FNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:F
Last Name:BERARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24486 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1835
Mailing Address - Country:US
Mailing Address - Phone:734-782-9417
Mailing Address - Fax:734-782-9417
Practice Address - Street 1:4545 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1913
Practice Address - Country:US
Practice Address - Phone:313-576-3310
Practice Address - Fax:313-576-1122
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237033163W00000X, 363LF0000X, 171000000X
NJ26NN07581200163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No171000000XOther Service ProvidersMilitary Health Care Provider