Healthcare Provider Details

I. General information

NPI: 1851648679
Provider Name (Legal Business Name): ANITA DENISE BERRY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 W BAUER RD
NAPERVILLE IL
60563-1108
US

IV. Provider business mailing address

993 W BAUER RD
NAPERVILLE IL
60563-1108
US

V. Phone/Fax

Practice location:
  • Phone: 630-408-1717
  • Fax: 888-909-5815
Mailing address:
  • Phone: 630-408-1717
  • Fax: 888-909-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041134386
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.002740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: