Provider Demographics
NPI:1316913528
Name:BERG, PAULA D (CNP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:D
Last Name:BERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 QUINCY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3631
Mailing Address - Country:US
Mailing Address - Phone:605-716-6656
Mailing Address - Fax:605-716-6623
Practice Address - Street 1:703 QUINCY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3631
Practice Address - Country:US
Practice Address - Phone:605-716-6656
Practice Address - Fax:605-716-6623
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR016377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR99029Medicare UPIN