Provider Demographics
NPI:1871635839
Name:BERKOWITZ, LOIS WENDY (RNBSN)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:WENDY
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 FARM HILL CT NE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4021
Mailing Address - Country:US
Mailing Address - Phone:404-403-2992
Mailing Address - Fax:
Practice Address - Street 1:753 FARM HILL CT NE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4021
Practice Address - Country:US
Practice Address - Phone:404-403-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN049242302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization