Provider Demographics
NPI:1639296783
Name:BERRY, VICTORIA ANNE
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ANNE
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 1:47 CUSHMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:ME
Mailing Address - Zip Code:04427
Mailing Address - Country:US
Mailing Address - Phone:207-884-8118
Mailing Address - Fax:
Practice Address - Street 1:47 CUSHMAN ROAD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427
Practice Address - Country:US
Practice Address - Phone:207-884-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider