Provider Demographics
NPI:1952050288
Name:BERRY, CAITLIN MK (NP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MK
Last Name:BERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 N HONEY CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3189
Mailing Address - Country:US
Mailing Address - Phone:414-615-5900
Mailing Address - Fax:414-615-5927
Practice Address - Street 1:1155 N HONEY CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3189
Practice Address - Country:US
Practice Address - Phone:414-615-5900
Practice Address - Fax:414-615-5927
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI196570-030163W00000X
WI12047-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse