Provider Demographics
NPI:1407186026
Name:BERRY, BEVERLY CRYSTAL (LPN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:CRYSTAL
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3214
Mailing Address - Country:US
Mailing Address - Phone:216-671-8876
Mailing Address - Fax:
Practice Address - Street 1:1933 W 58TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3214
Practice Address - Country:US
Practice Address - Phone:216-671-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126175IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse