Healthcare Provider Details

I. General information

NPI: 1376327452
Provider Name (Legal Business Name): TAYLOR BERGER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 E LINDA LN
GILBERT AZ
85234-6103
US

IV. Provider business mailing address

1831 E LINDA LN
GILBERT AZ
85234-6103
US

V. Phone/Fax

Practice location:
  • Phone: 509-539-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN187657
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: