Provider Demographics
NPI:1639733850
Name:BERRYMAN, ALISSA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:ELIZABETH
Last Name:BERRYMAN
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 1:321 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:EDGECOMB
Mailing Address - State:ME
Mailing Address - Zip Code:04556-3204
Mailing Address - Country:US
Mailing Address - Phone:207-350-6408
Mailing Address - Fax:
Practice Address - Street 1:321 SHORE RD
Practice Address - Street 2:
Practice Address - City:EDGECOMB
Practice Address - State:ME
Practice Address - Zip Code:04556-3204
Practice Address - Country:US
Practice Address - Phone:207-350-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN67208163W00000X
NH079592-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty