Individual
AILENE NICOLE BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
716 STEVENS AVE, PORTLAND, ME 04103-2656
(207) 283-0171
Mailing address
98 CHAROLAIS WAY, BURLINGTON, CT 06013-1627
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/22/2023
Last updated
09/22/2023
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