Provider Demographics
NPI:1316415920
Name:BERRY, MICHELE ANGELA
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANGELA
Last Name:BERRY
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 1:106 SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5165
Mailing Address - Country:US
Mailing Address - Phone:254-624-9932
Mailing Address - Fax:
Practice Address - Street 1:106 SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5165
Practice Address - Country:US
Practice Address - Phone:254-624-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764434163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse