Provider Demographics
NPI:1881868271
Name:BERRY, PATSY (RN, BSN, CLNC)
Entity Type:Individual
Prefix:MS
First Name:PATSY
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:RN, BSN, CLNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 WHEATSTONE ST
Mailing Address - Street 2:SPACE 171
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5433
Mailing Address - Country:US
Mailing Address - Phone:858-427-7616
Mailing Address - Fax:
Practice Address - Street 1:3078 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1322
Practice Address - Country:US
Practice Address - Phone:619-521-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA675233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse