Healthcare Provider Details

I. General information

NPI: 1447166517
Provider Name (Legal Business Name): MIKAELA BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48827 N BLACK CANYON HWY
NEW RIVER AZ
85087-6910
US

IV. Provider business mailing address

1928 E CIRCLE MOUNTAIN RD
NEW RIVER AZ
85087-7620
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-3500
  • Fax:
Mailing address:
  • Phone: 623-399-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number287778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: