Provider Demographics
NPI:1053903443
Name:BERTHOD, HOLLY (APRN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BERTHOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:RATCLIFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 PASCOAG MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-3103
Mailing Address - Country:US
Mailing Address - Phone:401-744-3374
Mailing Address - Fax:
Practice Address - Street 1:99 PASCOAG MAIN ST
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-3103
Practice Address - Country:US
Practice Address - Phone:401-744-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02465363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health