Provider Demographics
NPI:1336982552
Name:BERG, NICHOLAS CHRISTOPHER (MSN, RN, BSN)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:CHRISTOPHER
Last Name:BERG
Suffix:
Gender:M
Credentials:MSN, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 DEEBOYAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3353
Mailing Address - Country:US
Mailing Address - Phone:801-680-6666
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95219682163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics