Healthcare Provider Details

I. General information

NPI: 1356858252
Provider Name (Legal Business Name): ELLEN BERKENKEMPER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N CAMERON ST
WINCHESTER VA
22601-4899
US

IV. Provider business mailing address

301 N CAMERON ST
WINCHESTER VA
22601-4899
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-1680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12170595
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: