Provider Demographics
NPI:1881280386
Name:BERSTLER, FAITH TARA (RN)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:TARA
Last Name:BERSTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LAKE HAVASU AVE S APT A7
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-7539
Mailing Address - Country:US
Mailing Address - Phone:702-208-1128
Mailing Address - Fax:
Practice Address - Street 1:3437 JAMAICA BLVD S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-5507
Practice Address - Country:US
Practice Address - Phone:928-854-7280
Practice Address - Fax:928-854-7299
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ249396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse