Provider Demographics
NPI:1982445656
Name:BERGER, LEA (RN)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7502
Mailing Address - Country:US
Mailing Address - Phone:701-390-3517
Mailing Address - Fax:
Practice Address - Street 1:10 STANDING ROCK AVE
Practice Address - Street 2:
Practice Address - City:FORT YATES
Practice Address - State:ND
Practice Address - Zip Code:58538-8528
Practice Address - Country:US
Practice Address - Phone:701-854-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR54609163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency