Provider Demographics
NPI:1154113991
Name:BERETE, FANTA
Entity type:Individual
Prefix:
First Name:FANTA
Middle Name:
Last Name:BERETE
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 1:8905 WOODBURN CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM SEABROOK
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3520
Mailing Address - Country:US
Mailing Address - Phone:240-726-0896
Mailing Address - Fax:
Practice Address - Street 1:8905 WOODBURN CT
Practice Address - Street 2:
Practice Address - City:LANHAM SEABROOK
Practice Address - State:MD
Practice Address - Zip Code:20706-3520
Practice Address - Country:US
Practice Address - Phone:240-726-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide