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Individual
ALICE BERRY
Active
Individual
ALICE BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.E.
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
BAP-E-10167109
OR
Other
Enumeration date
12/22/2015
Last updated
12/22/2015
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