Provider Demographics
NPI:1881411379
Name:DEBERRY, LINDA
Entity type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:
Last Name:DEBERRY
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 1:2551 VILLA DR S APT 319
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3607
Mailing Address - Country:US
Mailing Address - Phone:701-219-8954
Mailing Address - Fax:
Practice Address - Street 1:2551 VILLA DR S APT 319
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3607
Practice Address - Country:US
Practice Address - Phone:701-219-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant