Provider Demographics
NPI:1821283094
Name:HARRIS-BERRYMAN, CASSIE EMBER
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:EMBER
Last Name:HARRIS-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 1:26190 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CALUMET
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2945
Mailing Address - Country:US
Mailing Address - Phone:906-231-7002
Mailing Address - Fax:
Practice Address - Street 1:26190 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-2945
Practice Address - Country:US
Practice Address - Phone:906-231-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse