Individual
MRS. SHANDA TENNEIL BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2365 W CENTRAL AVE, EL DORADO, KS 67042-3208
(316) 321-6036
(316) 321-6336
Mailing address
520 E AUGUSTA AVE, AUGUSTA, KS 67010-2100
(316) 775-5491
(316) 775-5442
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
13112826101
KS
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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