Healthcare Provider Details

I. General information

NPI: 1497486518
Provider Name (Legal Business Name): ELENA BERRY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA SHALON

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MILL AVE STE 123
TEMPE AZ
85281-6481
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number280124
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number280124
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06220676
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number293053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: