Provider Demographics
NPI:1699733709
Name:BERG, CHRISTINE (RN NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0213
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:955 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:KEWADIN
Practice Address - State:MI
Practice Address - Zip Code:49648-9371
Practice Address - Country:US
Practice Address - Phone:231-264-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008764960OtherBLUE CROSS BLUE SHIELD
MI5008764960OtherBLUE CROSS BLUE SHIELD
S67188Medicare UPIN