Healthcare Provider Details

I. General information

NPI: 1801396585
Provider Name (Legal Business Name): DEBORAH PRAIR BEREST CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9388 VALLEY VIEW DR NW STE 300
ALBUQUERQUE NM
87114-4908
US

IV. Provider business mailing address

5033 AGUA FRIA PARK RD
SANTA FE NM
87507-3424
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-3702
  • Fax:
Mailing address:
  • Phone: 505-699-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberR48866
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03512
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: