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General NPI Number Information
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NPI Number | 1710198601
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Entity Type | Individual
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Provider Name | AMANDA K. BERRY CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34TH ST. AND CIVIC CENTER BLVD. CHILDREN'S HOSPITAL OF PHILADELPHIA
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-590-2754
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Fax | 215-590-3985
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Provider Business Mailing Address
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Address Line | 1430 SOUTHWIND WAY
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City | DRESHER
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State | PA
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Zip | 19025-1026
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Country | US
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Telephone | 215-654-0447
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Fax | 215-590-3985
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | UP005978D
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License Number State | PA
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