Basic Information
| Provider Information | |||||||||
| NPI: | 1538500574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEROSKE | ||||||||
| FirstName: | MARCIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1670 UPHAM DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142939600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1670 UPHAM DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142939600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2013 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | COA.15448-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 28210549A | 01 | IN | STATE OF INDIANA, REGISTERED NURSE | OTHER | 71004484B | 01 | IN | STATE OF INDIANA CSR, PRESCRIPTIVE AUTHORITY | OTHER | RN.312282-COA1 | 01 | OH | REGISTERED NURSE CERTIFICATE OF AUTHORITY | OTHER | COA.15448-NP | 01 | OH | CERTIFIED NURSE PRACTITIONER | OTHER | RX.15448-EX1 | 01 | OH | PRESCRIPTIVE AUTHORITY-EXTERNSHIP | OTHER | 2013010755 | 01 | ANCC ID NUMBER | OTHER | 71004484A | 01 | IN | STATE OF INDIANA, APN, PRESCRIPTIVE AUTHORITY | OTHER |