Provider Demographics
NPI:1194716076
Name:BERUBE, MARY A (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:BERUBE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-4027
Mailing Address - Country:US
Mailing Address - Phone:603-487-3429
Mailing Address - Fax:603-487-2103
Practice Address - Street 1:52 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:NH
Practice Address - Zip Code:03070-4027
Practice Address - Country:US
Practice Address - Phone:603-487-3429
Practice Address - Fax:603-487-2103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH011346-23-05363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA6677OtherHPHC PIN
NH30003642Medicaid
NH0408373OtherUHC PIN
NHR74572OtherANTHEM REFERRING UPIN
NH011346OtherTUFTS PIN
NH41816OtherCIGNA PIN
NH0408373OtherUHC PIN
NHNP0234Medicare PIN