Provider Demographics
NPI:1831342039
Name:BERCH, MARY MARGARET
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BERCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NW STEWART PKWY
Mailing Address - Street 2:ANNEX A
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1281
Mailing Address - Country:US
Mailing Address - Phone:541-672-5667
Mailing Address - Fax:541-672-1048
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:ANNEX A
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1281
Practice Address - Country:US
Practice Address - Phone:541-672-5667
Practice Address - Fax:541-672-1048
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099007899RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health