Provider Demographics
NPI:1992761787
Name:BERGER, KATHY WAINSCOTT (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:WAINSCOTT
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 1:12304 172ND ST E
Mailing Address - Street 2:APT F201
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9193
Mailing Address - Country:US
Mailing Address - Phone:253-848-5861
Mailing Address - Fax:
Practice Address - Street 1:690 BARNES BLVD
Practice Address - Street 2:62 MDOS/SGOL
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-982-9917
Practice Address - Fax:253-982-2933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1060519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse