MEDICARE: MS. SONIA BERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	567297	TX

General Provider Information

NPI Number	:	1366551210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONIA BERRY

Provider Business Mailing Address
First Line	:	5202 MADDEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-2724
Country	:	US
Telephone Number	:	713-738-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	5202 MADDEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-2724
Country	:	US
Telephone Number	:	713-738-4515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/10/2008

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