1497860977 NPI number — MS. KARYN L. BERLIN LISW

Table of content: MS. KARYN L. BERLIN LISW (NPI 1497860977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497860977 NPI number — MS. KARYN L. BERLIN LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERLIN
Provider First Name:
KARYN
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERLIN
Provider Other First Name:
KARYN
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LISW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497860977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2224 HOLIDAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORALVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52241-2743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-338-0581
Provider Business Mailing Address Fax Number:
319-887-4920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HIGHWAY 6 W
Provider Second Line Business Practice Location Address:
IOWA CITY VA SPECIALTY 002B
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52246-2292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-338-0581
Provider Business Practice Location Address Fax Number:
319-887-4920
Provider Enumeration Date:
08/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  01422 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)