Healthcare Provider Details

I. General information

NPI: 1942308218
Provider Name (Legal Business Name): DIANNE J BERGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 DIXON AVE
LAFAYETTE CO
80026-8879
US

IV. Provider business mailing address

1455 DIXON AVE
LAFAYETTE CO
80026-8879
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-8500
  • Fax: 303-413-6325
Mailing address:
  • Phone: 303-443-8500
  • Fax: 303-413-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104808
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: