Provider Demographics
NPI:1982666095
Name:BERKSHIRE, DEBORAH A (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BERKSHIRE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORPORATION
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-452-9911
Mailing Address - Fax:
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORPORATION
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-452-9911
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN198685367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0932352Medicaid
OH0932352Medicaid