Provider Demographics
NPI:1114017746
Name:BERRY, PATRICIA H (CNP, ACHPN, GNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:H
Last Name:BERRY
Suffix:
Gender:F
Credentials:CNP, ACHPN, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 YORK AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1442
Mailing Address - Country:US
Mailing Address - Phone:801-243-6444
Mailing Address - Fax:
Practice Address - Street 1:STELLAHEALTH - LIVIO
Practice Address - Street 2:401 HARDING ST NE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413
Practice Address - Country:US
Practice Address - Phone:612-398-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-07-08
Deactivation Date:2020-01-30
Deactivation Code:
Reactivation Date:2020-06-26
Provider Licenses
StateLicense IDTaxonomies
UT5072870-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner