Provider Demographics
NPI:1487965653
Name:BERRY, CHRISTINA CAROL (RN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:CAROL
Last Name:BERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 N ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-1011
Mailing Address - Country:US
Mailing Address - Phone:978-249-8791
Mailing Address - Fax:978-249-8791
Practice Address - Street 1:1145 N ORANGE RD
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-1011
Practice Address - Country:US
Practice Address - Phone:978-249-8791
Practice Address - Fax:978-249-8791
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse