Provider Demographics
NPI:1821426487
Name:BERRY, AMBER CHRISTEL (ANP-BC, MSN)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:CHRISTEL
Last Name:BERRY
Suffix:
Gender:F
Credentials:ANP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:30 JORDAN LN
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1278
Practice Address - Country:US
Practice Address - Phone:860-263-0263
Practice Address - Fax:860-263-0267
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216584363LA2200X
CT113857363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health