Provider Demographics
NPI:1306204458
Name:BERHANG, COURTNEY LAUREN (APN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LAUREN
Last Name:BERHANG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 EDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2402
Mailing Address - Country:US
Mailing Address - Phone:732-801-4780
Mailing Address - Fax:
Practice Address - Street 1:221 EDWARD AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2402
Practice Address - Country:US
Practice Address - Phone:732-801-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00618900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily