Healthcare Provider Details

I. General information

NPI: 1831723972
Provider Name (Legal Business Name): JANENE BERCEAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26211 CENTRAL PARK BLVD
SOUTHFIELD MI
48076-4107
US

IV. Provider business mailing address

22667 FAWN RD
BROWNSTOWN TWP MI
48183-1155
US

V. Phone/Fax

Practice location:
  • Phone: 248-929-9371
  • Fax:
Mailing address:
  • Phone: 734-972-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704286041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: