Provider Demographics
NPI:1801396585
Name:BEREST, DEBORAH PRAIR (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PRAIR
Last Name:BEREST
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 AGUA FRIA PARK RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3424
Mailing Address - Country:US
Mailing Address - Phone:505-699-7323
Mailing Address - Fax:
Practice Address - Street 1:9388 VALLEY VIEW DR NW STE 300
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4908
Practice Address - Country:US
Practice Address - Phone:505-338-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48866163WH1000X
NMCNP-03512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice