Provider Demographics
NPI:1841888559
Name:BERENS, LILLIAN LOUISE
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:LOUISE
Last Name:BERENS
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 1:7780 MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-9628
Mailing Address - Country:US
Mailing Address - Phone:937-216-2095
Mailing Address - Fax:
Practice Address - Street 1:67 N TIPPECANOE DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1344
Practice Address - Country:US
Practice Address - Phone:937-667-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide