MEDICARE: DONNA L BERUBE RNFA

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	163WR0006X	Registered Nurse First Assistant	RN00156169	WA

General Provider Information

NPI Number	:	1316235773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA L BERUBE RNFA

Provider Business Mailing Address
First Line	:	2510 42ND AVE E
Second Line	:	#247
City	:	SEATTLE
State	:	WA
Zip	:	98112-2571
Country	:	US
Telephone Number	:	206-240-0398
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 42ND AVE E
Second Line	:	#247
City	:	SEATTLE
State	:	WA
Zip	:	98112-2571
Country	:	US
Telephone Number	:	206-240-0398
Fax Number	:

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/28/2012

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