Healthcare Provider Details

I. General information

NPI: 1699686378
Provider Name (Legal Business Name): CAITLIN MARIE BERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 OXFORD ST
GRAND FORKS ND
58202-6092
US

IV. Provider business mailing address

1114 N 39TH ST APT 4
GRAND FORKS ND
58203-2085
US

V. Phone/Fax

Practice location:
  • Phone: 315-486-1012
  • Fax:
Mailing address:
  • Phone: 315-486-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN61653352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: