Provider Demographics
NPI:1811311897
Name:BEROLO, MAGGIE ANN (NP)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ANN
Last Name:BEROLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 PFEIFFER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4872
Mailing Address - Country:US
Mailing Address - Phone:833-358-2113
Mailing Address - Fax:
Practice Address - Street 1:50 E RIVERCENTER BLVD STE 434
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1660
Practice Address - Country:US
Practice Address - Phone:833-358-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306767-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health