Healthcare Provider Details

I. General information

NPI: 1740688514
Provider Name (Legal Business Name): SIRI BERINGER RN, BSRN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5730
  • Fax:
Mailing address:
  • Phone: 520-324-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN153289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: