Healthcare Provider Details

I. General information

NPI: 1083235592
Provider Name (Legal Business Name): JENNIFER MICHELLE BERG STEPP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER MICHELLE BERG

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17487 S HEALTHCARE DR
LAVEEN AZ
85339-8500
US

IV. Provider business mailing address

17487 S HEALTHCARE DR
LAVEEN AZ
85339-8500
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax: 520-694-1640
Mailing address:
  • Phone: 520-550-6000
  • Fax: 520-550-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68123
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR77940
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: