Provider Demographics
NPI:1215539606
Name:BERRY, SARAH (MS, RN, PNP-PC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, RN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2916
Mailing Address - Country:US
Mailing Address - Phone:404-401-9676
Mailing Address - Fax:
Practice Address - Street 1:4633 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2916
Practice Address - Country:US
Practice Address - Phone:404-401-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95168418163W00000X
CA95015203363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse