Healthcare Provider Details

I. General information

NPI: 1306315486
Provider Name (Legal Business Name): MAXWELL ALAN BERSCHEIT NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-2540
  • Fax: 320-763-5749
Mailing address:
  • Phone: 763-913-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5900
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: