Provider Demographics
NPI:1699927392
Name:BERGER, LIZANNE JACLYN (CRNP)
Entity type:Individual
Prefix:
First Name:LIZANNE
Middle Name:JACLYN
Last Name:BERGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1505
Mailing Address - Country:US
Mailing Address - Phone:215-873-9251
Mailing Address - Fax:215-887-3237
Practice Address - Street 1:4833 HULMEVILLE RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3023
Practice Address - Country:US
Practice Address - Phone:215-638-5200
Practice Address - Fax:215-638-3252
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003987-C363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care