Provider Demographics
NPI:1417218132
Name:BERRY, NAHDIKA A (FNP-C)
Entity type:Individual
Prefix:
First Name:NAHDIKA
Middle Name:A
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-435-3666
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:11200 W PARKLAND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3127
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150937-030163W00000X
WI5018-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse