Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704278404 | MI |
NPI | 1003345729 |
---|---|
Provider Name | Leyla Q Berry |
First Address | Ann Arbor, MI 48109-1050 |
Second Address | Ann Arbor, MI 48109-1050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 12/07/2019 |