Provider Demographics
NPI:1104597442
Name:BERRY, STEFANIE LIEN (CPNP-AC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LIEN
Last Name:BERRY
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2260
Mailing Address - Country:US
Mailing Address - Phone:512-659-3270
Mailing Address - Fax:
Practice Address - Street 1:1919 S BRAESWOOD BLVD STE 5330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4466
Practice Address - Country:US
Practice Address - Phone:832-827-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049388363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics