Provider Demographics
NPI:1740557966
Name:BERBERICH, MARIE ANNE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANNE
Last Name:BERBERICH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:ANNE
Other - Last Name:KETCHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 WALNUT ROAD
Mailing Address - Street 2:PO BOX 1228
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-1228
Mailing Address - Country:US
Mailing Address - Phone:845-635-1778
Mailing Address - Fax:
Practice Address - Street 1:11 WALNUT ROAD
Practice Address - Street 2:HICKORY HILL ESTATES
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569
Practice Address - Country:US
Practice Address - Phone:845-635-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635530-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse