Provider Demographics
NPI:1750446944
Name:BERMAN, BILLIE SUE (NP)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:SUE
Last Name:BERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8989
Mailing Address - Country:US
Mailing Address - Phone:517-339-1997
Mailing Address - Fax:
Practice Address - Street 1:2310 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4018
Practice Address - Country:US
Practice Address - Phone:517-346-7628
Practice Address - Fax:517-346-7629
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704097959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704097959OtherSTATE LICENSE
MI0853310215OtherBLUE SHIELD PROVIDER NO
MI4704097959OtherSTATE LICENSE