Provider Demographics
NPI:1205348422
Name:BERAN, CHRISTINE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:BERAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CORNELL LN
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:MA
Mailing Address - Zip Code:01235-9215
Mailing Address - Country:US
Mailing Address - Phone:413-344-5108
Mailing Address - Fax:
Practice Address - Street 1:31 ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-2223
Practice Address - Country:US
Practice Address - Phone:413-329-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN49685164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse