Provider Demographics
NPI:1316122765
Name:BERRIAN, JODIE ELIZABETH (CRNA)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ELIZABETH
Last Name:BERRIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48129
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8329
Mailing Address - Country:US
Mailing Address - Phone:908-994-5204
Mailing Address - Fax:908-994-5061
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:908-994-5204
Practice Address - Fax:908-994-5061
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12088100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123343RLHMedicare PIN