Healthcare Provider Details

I. General information

NPI: 1508875006
Provider Name (Legal Business Name): KATHLEEN MARY BERIAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

IV. Provider business mailing address

75 WINFIELD RD
HOLDEN MA
01520-2442
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1260
  • Fax:
Mailing address:
  • Phone: 508-829-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number174024
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: