Provider Demographics
NPI:1427062975
Name:BERG, SARAH (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 DOUGLAS BLVD
Mailing Address - Street 2:STE 325
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4289
Mailing Address - Country:US
Mailing Address - Phone:925-944-0351
Mailing Address - Fax:925-944-1957
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:STE 210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-944-0351
Practice Address - Fax:925-944-1957
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN624462363L00000X
CANPF16426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0020610Medicaid
CAQ70709Medicare UPIN
CAZZZ02563ZMedicare ID - Type UnspecifiedPPIN
CAGR0020610Medicaid