Provider Demographics
NPI:1760690879
Name:BERRY, AMY MARIE (ANP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 NE 136TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-450-6800
Mailing Address - Fax:360-989-1150
Practice Address - Street 1:234 NE 136TH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-450-6800
Practice Address - Fax:360-989-1150
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350040NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health