Provider Demographics
NPI:1932618063
Name:BERSCHEID, ANN MARIE
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BERSCHEID
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:PO BOX 1253
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156
Mailing Address - Country:US
Mailing Address - Phone:208-610-3368
Mailing Address - Fax:
Practice Address - Street 1:424 SOUTH MARIAN
Practice Address - Street 2:
Practice Address - City:OLDTOWN
Practice Address - State:ID
Practice Address - Zip Code:83822
Practice Address - Country:US
Practice Address - Phone:208-217-0837
Practice Address - Fax:208-217-0837
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist