Provider Demographics
NPI:1871801019
Name:BERK, KELLY MARIE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:BERK
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 VALLEY CENTER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2267
Mailing Address - Country:US
Mailing Address - Phone:610-954-2821
Mailing Address - Fax:484-893-7096
Practice Address - Street 1:1510 VALLEY CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2267
Practice Address - Country:US
Practice Address - Phone:610-954-2821
Practice Address - Fax:484-893-7096
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN526773L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health