Provider Demographics
NPI:1134705510
Name:BERRY, MARY LOU (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
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 1:61 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1548
Mailing Address - Country:US
Mailing Address - Phone:978-774-5038
Mailing Address - Fax:
Practice Address - Street 1:61 SUMMER ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1548
Practice Address - Country:US
Practice Address - Phone:978-774-5038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse