Healthcare Provider Details

I. General information

NPI: 1790769552
Provider Name (Legal Business Name): ANN-MARIE H BERG C..P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 10TH ST SE SUITE 150
CEDAR RAPIDS IA
52403-2442
US

IV. Provider business mailing address

411 10TH ST SE SUITE 150
CEDAR RAPIDS IA
52403-2442
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-3600
  • Fax: 319-363-9971
Mailing address:
  • Phone: 319-363-3600
  • Fax: 319-363-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC-095353
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: