Maryellen Berthiaume, REGISTERED NURSE

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

4704237854 Issued in MI

Practice address

26180 Outer Dr
Lincoln Park, MI 48146-2084

Phone

(313) 389-7558

Fax

(313) 383-7293

NPI assigned

Nov 6, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509926400000",
    "number": "1700399375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26180 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-389-7558",
            "fax_number": "313-383-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26180 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-389-7558",
            "fax_number": "313-383-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTHIAUME",
        "first_name": "MARYELLEN",
        "name_prefix": "Ms.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-06",
        "last_updated": "2017-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MI",
            "license": "4704237854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Psychiatric/Mental Health Registered Nurse in Lincoln Park, MI
• Providers in Lincoln Park, MI by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.