Healthcare Provider Details

I. General information

NPI: 1235921230
Provider Name (Legal Business Name): HALEY JEAN BERBERICK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEY JEAN SKIVER

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N PORT LN
HURON OH
44839-2339
US

IV. Provider business mailing address

103 PARKVIEW PL
BELLEVUE OH
44811-9057
US

V. Phone/Fax

Practice location:
  • Phone: 419-217-6317
  • Fax:
Mailing address:
  • Phone: 419-217-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.154449.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: