Healthcare Provider Details

I. General information

NPI: 1851064471
Provider Name (Legal Business Name): AMANDA CAROLE BERG BSN, RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BERG

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL SURGERY DEPT
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-5022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number009979
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432100
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number719844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: