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General NPI Number Information
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NPI Number | 1639568389
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Entity Type | Organization
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Legal Business Name | BARRY S BERUMEN APRN-NP, PMHNP-BC, LLC
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 810 N 48TH ST STE 1
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City | LINCOLN
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State | NE
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Zip | 68504-3367
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Country | US
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Telephone | 402-802-0726
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Fax | 402-477-3655
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Provider Business Mailing Address
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Address Line | 810 N 48TH ST STE 1
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City | LINCOLN
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State | NE
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Zip | 68504-3367
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Country | US
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Telephone | 402-802-0726
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Fax | 402-477-3655
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | REBECCA LUETHKE
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Credential | CPC
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Telephone | 402-646-5052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 111736
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License Number State | NE
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