Provider Demographics
NPI:1346593134
Name:BERRY, CHANTAL (CNM)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 VAN NESS TER
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3324
Mailing Address - Country:US
Mailing Address - Phone:732-670-4109
Mailing Address - Fax:
Practice Address - Street 1:27 VAN NESS TER
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3324
Practice Address - Country:US
Practice Address - Phone:732-670-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME000521000367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife