MEDICARE: MOLLY REBECCA BERG CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP1700X	Perinatal Nurse Practitioner	CP000444	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	924114229808	OTHER	MN	PRIMEWEST
2	9243925	OTHER	SD	DAKOTACARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2387950	OTHER	SD	ARAZ/ AMERICA'S PPO
5	370624200	OTHER	SD	DEPT OF LABOR
6	HP55698	OTHER	SD	HEALTHPARTNERS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	0705288	OTHER	SD	MEDICA
10	263P6DA	OTHER	MN	CC SYSTEMS/ BLUE PLUS
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	283761045257	OTHER	SD	PREFERRED ONE
13	57105AD04	OTHER	SD	WPS TRICARE
14	263P6DA	OTHER	MN	BLUE CROSS
15	4994372	OTHER	SD	BLUE CROSS
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	248008	OTHER	SD	MIDLANDS CHOICE

General Provider Information

NPI Number	:	1902878523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY REBECCA BERG CNP

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	1417 S CLIFF AVE
Second Line	:	STE 100
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1063
Country	:	US
Telephone Number	:	605-322-8937
Fax Number	:	605-322-8938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	10/10/2018

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