Healthcare Provider Details

I. General information

NPI: 1578078465
Provider Name (Legal Business Name): HEATHER BERGER CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N CURTIS RD STE 101
BOISE ID
83706-1348
US

IV. Provider business mailing address

1075 N CURTIS RD STE 101
BOISE ID
83706-1348
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-7463
  • Fax: 208-367-7507
Mailing address:
  • Phone: 208-367-7463
  • Fax: 208-367-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: