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General NPI Number Information
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NPI Number | 1679549778
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Entity Type | Individual
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Provider Name | LISA F. BERARD FNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 4545 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-1913
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Country | US
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Telephone | 313-576-3310
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Fax | 313-576-1122
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Provider Business Mailing Address
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Address Line | 24486 SUMMER LN
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City | FLAT ROCK
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State | MI
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Zip | 48134-1835
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Country | US
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Telephone | 734-782-9417
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Fax | 734-782-9417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704237033
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 26NN07581200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704237033
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NN07581200
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 4704237033
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License Number State | MI
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