Provider Demographics
NPI:1730707019
Name:BERRY, TONIA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:MARIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:IA
Mailing Address - Zip Code:51450-7717
Mailing Address - Country:US
Mailing Address - Phone:712-657-8513
Mailing Address - Fax:
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:IA
Practice Address - Zip Code:51450-7717
Practice Address - Country:US
Practice Address - Phone:712-657-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA159048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily