Provider Demographics
NPI:1215253190
Name:BERG, JANET MARIE (MS, RN)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:BERG
Suffix:
Gender:F
Credentials:MS, RN
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:BRUMBLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RN
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-4440
Mailing Address - Fax:102-529-8161
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4440
Practice Address - Fax:210-539-8161
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-42194163WG0000X, 163WP0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No174400000XOther Service ProvidersSpecialist