MEDICARE: JULIANNE TARA BERISH CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.023192	OH

General Provider Information

NPI Number	:	1144702754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE TARA BERISH CNP

Provider Business Mailing Address
First Line	:	5595 TRANSPORTATION BLVD STE 220
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5359
Country	:	US
Telephone Number	:	216-587-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	5595 TRANSPORTATION BLVD STE 220
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5359
Country	:	US
Telephone Number	:	216-587-5431
Fax Number	:	216-587-5474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	09/23/2020

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