Provider Demographics
NPI:1245343573
Name:CAIN-BERK, BEVORLY FHAMORE (NP)
Entity type:Individual
Prefix:
First Name:BEVORLY
Middle Name:FHAMORE
Last Name:CAIN-BERK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BEVORLY
Other - Middle Name:FHAMORE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4105 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1033
Mailing Address - Country:US
Mailing Address - Phone:408-620-1166
Mailing Address - Fax:408-912-5340
Practice Address - Street 1:4105 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1033
Practice Address - Country:US
Practice Address - Phone:408-620-1166
Practice Address - Fax:408-912-5340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN614337363LW0102X
CANP 14109363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology