Provider Demographics
NPI:1184278871
Name:BERVE, HANNAH (BS, MS, RD, PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BERVE
Suffix:
Gender:
Credentials:BS, MS, RD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COPELAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3120
Mailing Address - Country:US
Mailing Address - Phone:928-460-3478
Mailing Address - Fax:
Practice Address - Street 1:1343 N ALMA SCHOOL RD STE 160
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5901
Practice Address - Country:US
Practice Address - Phone:480-963-1853
Practice Address - Fax:480-963-1854
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00806200363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ561904Medicaid