MEDICARE: MYRA JEAN BERCY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1548967789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRA JEAN BERCY

Provider Business Mailing Address
First Line	:	7820 UNITY DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-2027
Country	:	US
Telephone Number	:	504-228-9972
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 TULANE AVE BLDG 3
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7186
Country	:	US
Telephone Number	:	504-302-1323
Fax Number	:

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

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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