Provider Demographics
NPI:1366772436
Name:BERMAN, NICOLE A (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:BERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15070 STILLWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8508
Mailing Address - Country:US
Mailing Address - Phone:440-635-0231
Mailing Address - Fax:
Practice Address - Street 1:15070 STILLWELL RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8508
Practice Address - Country:US
Practice Address - Phone:440-635-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342415163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse