Provider Demographics
NPI:1538500574
Name:BEROSKE, MARCIE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:
Last Name:BEROSKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 S PIERCE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4592
Mailing Address - Country:US
Mailing Address - Phone:720-664-5594
Mailing Address - Fax:720-706-6079
Practice Address - Street 1:7345 S PIERCE ST STE 110
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4592
Practice Address - Country:US
Practice Address - Phone:720-664-5594
Practice Address - Fax:720-706-6079
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15448-NP363LP0808X
COAPN.0991987-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013010755OtherANCC ID NUMBER
IN28210549AOtherSTATE OF INDIANA, REGISTERED NURSE
OHRN.312282-COA1OtherREGISTERED NURSE CERTIFICATE OF AUTHORITY
OHCOA.15448-NPOtherCERTIFIED NURSE PRACTITIONER
IN71004484AOtherSTATE OF INDIANA, APN, PRESCRIPTIVE AUTHORITY
IN71004484BOtherSTATE OF INDIANA CSR, PRESCRIPTIVE AUTHORITY
OHRX.15448-EX1OtherPRESCRIPTIVE AUTHORITY-EXTERNSHIP