Provider Demographics
NPI:1225092281
Name:BERG, JUDITH (NP)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 INDEPENDENCE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6713
Mailing Address - Country:US
Mailing Address - Phone:303-456-5495
Mailing Address - Fax:303-456-7490
Practice Address - Street 1:2655 CRESCENT DR STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3373
Practice Address - Country:US
Practice Address - Phone:303-443-4200
Practice Address - Fax:303-443-5470
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994592-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200451850Medicaid
IN164220KMedicare PIN
IN164210KMedicare PIN
IN703060NMedicare PIN