Healthcare Provider Details

I. General information

NPI: 1578616983
Provider Name (Legal Business Name): ANNA MARIE BERRIAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/16/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PVMHS STUDENT HEALTH CENTER 485 LOWELL STREET
PEABODY MA
01960
US

IV. Provider business mailing address

27 CONGRESS ST STE 513
SALEM MA
01970-5523
US

V. Phone/Fax

Practice location:
  • Phone: 978-536-4720
  • Fax:
Mailing address:
  • Phone: 781-334-7109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number240615
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN240615
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: