Healthcare Provider Details

I. General information

NPI: 1851232383
Provider Name (Legal Business Name): ELIZABETH CAITLIN BERUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28557 W 160TH ST
GARDNER KS
66030-9405
US

IV. Provider business mailing address

28557 W 160TH ST
GARDNER KS
66030-9405
US

V. Phone/Fax

Practice location:
  • Phone: 913-449-0944
  • Fax:
Mailing address:
  • Phone: 913-449-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-143742-071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: