MEDICARE: JUANA BERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	882040	TX
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1639727522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA BERRY

Provider Business Mailing Address
First Line	:	2042 WILD CREEK CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75253-5472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 WILD CREEK CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75253-5472
Country	:	US
Telephone Number	:	972-342-8527
Fax Number	:	972-286-8330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	05/04/2020

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Directions to “ JUANA BERRY ” Practice Location

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