Healthcare Provider Details

I. General information

NPI: 1457927444
Provider Name (Legal Business Name): DONNA J BEREN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

IV. Provider business mailing address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-6200
  • Fax: 702-483-6202
Mailing address:
  • Phone: 702-483-6200
  • Fax: 702-483-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number876928
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704259740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: