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Individual

ELSA PETRONELLA VAN BERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRYT, RN, MSN,FNP-BC

Contact information

Practice address
3100 SUMMIT ST FL 2, OAKLAND, CA 94609-3412
(510) 869-8865
(510) 869-6271
Mailing address
3687 MT DIABLO BLVD STE 200, LAFAYETTE, CA 94549-3746
(510) 204-6660

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2011003399
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
55-1876
MEDICARE PROVIDER #
CA
Enumeration date
10/28/2013
Last updated
12/12/2017
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