Provider Demographics
NPI:1629524178
Name:BERRY, AMBER RENEE (MSN RN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RENEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W MARKET ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3335
Mailing Address - Country:US
Mailing Address - Phone:330-606-9561
Mailing Address - Fax:
Practice Address - Street 1:3200 W MARKET ST
Practice Address - Street 2:SUITE 111
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3335
Practice Address - Country:US
Practice Address - Phone:330-606-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.220278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse