Individual
MR. ETHAN A BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN CRNA
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(909) 967-1734
Mailing address
10203 NE 102ND ST, VANCOUVER, WA 98662
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200560041CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
200560041CRNA
OR
Other
Enumeration date
08/24/2006
Last updated
11/20/2009
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