Organization
BEREA COLLEGE HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOROTHY EILEEN MAU (OFFICE MANAGER)
(859) 985-3212
Entity
Organization
Contact information
Practice address
305 ESTILL ST, BEREA, KY 40403-1742
(859) 985-3212
(859) 985-3910
Mailing address
305 ESTILL ST, BEREA, KY 40403-1742
(859) 985-3212
(859) 985-3910
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
23321
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1353P
JOAN MOORE, ARNP
KY
Enumeration date
10/27/2006
Last updated
11/29/2023
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