Provider Demographics
NPI:1679998256
Name:BERRY, BEATRICE (RN)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BEATRICE
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1175 E MAIN ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7457
Mailing Address - Country:US
Mailing Address - Phone:541-776-9167
Mailing Address - Fax:
Practice Address - Street 1:1175 E MAIN ST STE 2F
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7457
Practice Address - Country:US
Practice Address - Phone:541-776-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081025144RN163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator