Healthcare Provider Details

I. General information

NPI: 1154650562
Provider Name (Legal Business Name): SARAH C BERRA ANP-BC,OCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14805 N OUTER 40 RD SUITE 320
CHESTERFIELD MO
63017-6060
US

IV. Provider business mailing address

14805 N OUTER 40 RD SUITE 320
CHESTERFIELD MO
63017-6060
US

V. Phone/Fax

Practice location:
  • Phone: 888-811-4677
  • Fax: 800-605-8906
Mailing address:
  • Phone: 888-811-4677
  • Fax: 800-605-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2000149116
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: