Provider Demographics
NPI:1427381508
Name:BERRY, NOEL RENEE (RN)
Entity type:Individual
Prefix:MISS
First Name:NOEL
Middle Name:RENEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 FAUSTINA AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2810
Mailing Address - Country:US
Mailing Address - Phone:419-569-1658
Mailing Address - Fax:
Practice Address - Street 1:911 FAUSTINA AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2810
Practice Address - Country:US
Practice Address - Phone:419-569-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH353165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse