Provider Demographics
NPI:1922874007
Name:BERRY, JULIE ANNE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:BERRY
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 1:400 DOMINY RD
Mailing Address - Street 2:
Mailing Address - City:LONE PINE
Mailing Address - State:CA
Mailing Address - Zip Code:93545-9755
Mailing Address - Country:US
Mailing Address - Phone:530-228-5336
Mailing Address - Fax:760-878-0444
Practice Address - Street 1:550 S. CLAY ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:CA
Practice Address - Zip Code:93526
Practice Address - Country:US
Practice Address - Phone:760-878-0324
Practice Address - Fax:760-878-0444
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594854163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse