Provider Demographics
NPI:1457927444
Name:BEREN, DONNA J (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:BEREN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4752
Mailing Address - Country:US
Mailing Address - Phone:810-771-4704
Mailing Address - Fax:
Practice Address - Street 1:17100 SILVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3468
Practice Address - Country:US
Practice Address - Phone:810-936-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259740363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care