Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE60477432 | WA |
N | 1223G0001X | General Practice | D8301 | OR |
N | 213EG0000X | General Practice | D8301 | OR |
NPI | 1396800033 |
---|---|
Provider Name | Dr. Hillary Anne Berry |
First Address | Hayden, ID 83835-1387 |
Second Address | Coeur D Alene, ID 83814-2785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 05/12/2018 |