Healthcare Provider Details

I. General information

NPI: 1003157975
Provider Name (Legal Business Name): ELIZABETH BERRY MS. RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 E GRANITE VIEW DR
PHOENIX AZ
85048-4344
US

IV. Provider business mailing address

2018 E GRANITE VIEW DR
PHOENIX AZ
85048-4344
US

V. Phone/Fax

Practice location:
  • Phone: 602-770-1335
  • Fax:
Mailing address:
  • Phone: 602-770-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: