MEDICARE: DIANE LYNN BERTHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285372078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE LYNN BERTHA

Provider Business Mailing Address
First Line	:	3854 MARION DR
Second Line	:
City	:	WEIRTON
State	:	WV
Zip	:	26062-5245
Country	:	US
Telephone Number	:	304-748-0596
Fax Number	:

Provider Business Practice Location Address
First Line	:	3854 MARION DR
Second Line	:
City	:	WEIRTON
State	:	WV
Zip	:	26062-5245
Country	:	US
Telephone Number	:	304-748-0596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “ DIANE LYNN BERTHA ” Practice Location

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