Provider Demographics
NPI:1801060280
Name:NARCRISSA BERRY
Entity type:Organization
Organization Name:NARCRISSA BERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTION PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NARCRISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-667-4490
Mailing Address - Street 1:4308 KLATT ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-2230
Mailing Address - Country:US
Mailing Address - Phone:630-667-4490
Mailing Address - Fax:
Practice Address - Street 1:4308 KLATT ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-2230
Practice Address - Country:US
Practice Address - Phone:630-667-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB60062176904347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle