Provider Demographics
NPI:1639611858
Name:WENDY L. BERMAN APRN BC LLC
Entity type:Organization
Organization Name:WENDY L. BERMAN APRN BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN BC
Authorized Official - Phone:802-274-4909
Mailing Address - Street 1:9 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1737
Mailing Address - Country:US
Mailing Address - Phone:802-274-4909
Mailing Address - Fax:781-422-3070
Practice Address - Street 1:36 N BEDFORD ST
Practice Address - Street 2:
Practice Address - City:E BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1186
Practice Address - Country:US
Practice Address - Phone:802-274-4909
Practice Address - Fax:781-422-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2295462364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
003931Medicare PIN