Healthcare Provider Details

I. General information

NPI: 1487965653
Provider Name (Legal Business Name): CHRISTINA CAROL BERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 N ORANGE RD
ATHOL MA
01331-1011
US

IV. Provider business mailing address

1145 N ORANGE RD
ATHOL MA
01331-1011
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-8791
  • Fax: 978-249-8791
Mailing address:
  • Phone: 978-249-8791
  • Fax: 978-249-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236162
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: