Provider Demographics
NPI:1548481633
Name:BERHORST, BERNICE ELAINE (CNA)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:ELAINE
Last Name:BERHORST
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 EL PARADISO
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AL
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-775-6666
Mailing Address - Fax:480-730-9797
Practice Address - Street 1:2653 EL PARADISO
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AL
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-775-6666
Practice Address - Fax:480-730-9797
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCNA828975289164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse