Provider Demographics
NPI:1982855714
Name:BERRY, NICOLE DIONE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DIONE
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14055 CEDAR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3333
Mailing Address - Country:US
Mailing Address - Phone:216-223-6277
Mailing Address - Fax:216-223-6279
Practice Address - Street 1:14055 CEDAR RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44118-3333
Practice Address - Country:US
Practice Address - Phone:216-223-6277
Practice Address - Fax:216-223-6279
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2020-12-01
Deactivation Date:2018-08-02
Deactivation Code:
Reactivation Date:2018-08-08
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022612363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily