Provider Demographics
NPI:1093439622
Name:BERRY-GBEKOU, VICTORINE E
Entity Type:Individual
Prefix:
First Name:VICTORINE
Middle Name:E
Last Name:BERRY-GBEKOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 LONGTREE DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5546
Mailing Address - Country:US
Mailing Address - Phone:850-339-7746
Mailing Address - Fax:
Practice Address - Street 1:57 FORSYTH ST NW FL 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2229
Practice Address - Country:US
Practice Address - Phone:850-339-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025479363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health