Provider Demographics
NPI:1831570928
Name:BERARDI, BILLIE (STNA)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:BERARDI
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MRS
Other - First Name:BILLIE
Other - Middle Name:JO
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1744 DUMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440
Mailing Address - Country:US
Mailing Address - Phone:330-951-4112
Mailing Address - Fax:
Practice Address - Street 1:1744 DUMONT DRIVE
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440
Practice Address - Country:US
Practice Address - Phone:330-951-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400666690907376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCS1511300311OtherCARESOURCE
OH0118229Medicaid