Individual
MRS. LISA MICHELLE BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
22 DIANE DR, MANORVILLE, NY 11949-3033
(631) 793-0587
Mailing address
22 DIANE DR, MANORVILLE, NY 11949-3033
(631) 793-0587
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
351231
NY
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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