Provider Demographics
NPI:1194595124
Name:BERG, SARAH (LPN BAWS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:LPN BAWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3450
Mailing Address - Country:US
Mailing Address - Phone:319-520-6060
Mailing Address - Fax:
Practice Address - Street 1:1313 WESTERN DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3450
Practice Address - Country:US
Practice Address - Phone:319-520-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV849701164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse