Provider Demographics
NPI:1811881295
Name:BERG, DAVID CARL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CARL
Last Name:BERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16440 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1167
Mailing Address - Country:US
Mailing Address - Phone:402-630-1523
Mailing Address - Fax:
Practice Address - Street 1:4060 VINTON ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-3863
Practice Address - Country:US
Practice Address - Phone:402-503-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide