Provider Demographics
NPI:1629857263
Name:BERRY, REBECCA (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 TOMAQUAG VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02808-1720
Mailing Address - Country:US
Mailing Address - Phone:401-622-5700
Mailing Address - Fax:
Practice Address - Street 1:132 OLD RIVER RD STE 108
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1397
Practice Address - Country:US
Practice Address - Phone:401-334-1044
Practice Address - Fax:401-334-1054
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily