Provider Demographics
NPI:1386701795
Name:DOSS, BERTHA M (CRNA)
Entity type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:M
Last Name:DOSS
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 1:8306 WILSHIRE BLVD APT 1529
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-497-2483
Mailing Address - Fax:
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2740
Practice Address - Country:US
Practice Address - Phone:860-826-6395
Practice Address - Fax:860-823-6563
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV71264367500000X
CT003771367500000X
IL209001074367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV71264OtherRN REGISTRATION
WV3810010339Medicaid
WV71264OtherRN REGISTRATION