Healthcare Provider Details

I. General information

NPI: 1851568000
Provider Name (Legal Business Name): TERESA CATHERINE BERT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQUARE SUITE 205
PROVIDENCE RI
02904
US

IV. Provider business mailing address

1 RANDALL SQUARE SUITE 205
PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-7178
  • Fax: 401-331-6180
Mailing address:
  • Phone: 401-331-7178
  • Fax: 401-331-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number23412
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: