Healthcare Provider Details

I. General information

NPI: 1205726635
Provider Name (Legal Business Name): LILIANA BERRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PAGE PARK DR
POUGHKEEPSIE NY
12603-7500
US

IV. Provider business mailing address

22 N WHITE ST
POUGHKEEPSIE NY
12601-3422
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2850
  • Fax:
Mailing address:
  • Phone: 845-206-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number994232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: