Provider Demographics
NPI:1942529540
Name:BERENZ, DAVIDA ANN (RN)
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:ANN
Last Name:BERENZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDGAR
Mailing Address - State:WI
Mailing Address - Zip Code:54426-9422
Mailing Address - Country:US
Mailing Address - Phone:715-443-2732
Mailing Address - Fax:
Practice Address - Street 1:2262 5TH AVE
Practice Address - Street 2:
Practice Address - City:EDGAR
Practice Address - State:WI
Practice Address - Zip Code:54426-9422
Practice Address - Country:US
Practice Address - Phone:715-443-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse