Healthcare Provider Details

I. General information

NPI: 1689117004
Provider Name (Legal Business Name): JOHN BERLIN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15954 RIVERS EDGE DR
HAYWARD WI
54843-7800
US

IV. Provider business mailing address

15954 RIVERS EDGE DR
HAYWARD WI
54843-7800
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-2541
  • Fax: 715-934-5189
Mailing address:
  • Phone: 715-634-2541
  • Fax: 715-934-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number172629
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: