Provider Demographics
NPI:1790800662
Name:BERRY-RICHARDSON, DANA STEPHENS (APRN- BC)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:STEPHENS
Last Name:BERRY-RICHARDSON
Suffix:
Gender:F
Credentials:APRN- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 PROVINCIAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4117
Mailing Address - Country:US
Mailing Address - Phone:734-975-2738
Mailing Address - Fax:
Practice Address - Street 1:5361 MCAULEY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-712-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704153539363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health