| NPI | 1316021793 |
|---|---|
| Former Name | CONNIE LEANNE BERRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085-002129) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 085.002129) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2021-12-20 |