Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-128728 | IL |
N | 208600000X | Surgeon | 036-128728 | IL |
Y | 2082S0105X | Plastic Hand Surgeon | 036-128728 | IL |
NPI | 1619198157 |
---|---|
Provider Name | Nada Berry |
First Address | Springfield, IL 62794-9653 |
Second Address | Springfield, IL 62702-6700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 18/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036128728 | (05) | IL |