Individual
LATISHIA RENEE-DENISE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
880 W LONG LAKE RD, TROY, MI 48098-4504
(888) 562-5442
(562) 528-5595
Mailing address
200 OCEANGATE STE 100, LONG BEACH, CA 90802-4317
(562) 499-6191
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704277302
MI
Other
Enumeration date
04/29/2013
Last updated
01/11/2018
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