Provider Demographics
NPI:1154782027
Name:BERRY-BURKHART, MICHELLE OLIVER
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:OLIVER
Last Name:BERRY-BURKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S OLYMPIA ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5247
Mailing Address - Country:US
Mailing Address - Phone:509-318-3194
Mailing Address - Fax:
Practice Address - Street 1:828 S OLYMPIA ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5247
Practice Address - Country:US
Practice Address - Phone:509-318-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide