Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01056952A | IN |
NPI | 1053572578 |
---|---|
Provider Name | Dr. Carol Lynn Berseth |
First Address | Evansville, IN 47715-3632 |
Second Address | Evansville, IN 47715-3632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D82126 | (02) | MN |