Provider Demographics
NPI:1831723972
Name:BERCEAU, JANENE (RN)
Entity type:Individual
Prefix:MS
First Name:JANENE
Middle Name:
Last Name:BERCEAU
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 1:22667 FAWN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1155
Mailing Address - Country:US
Mailing Address - Phone:734-972-4209
Mailing Address - Fax:
Practice Address - Street 1:26211 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4107
Practice Address - Country:US
Practice Address - Phone:248-929-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286041163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator