Healthcare Provider Details

I. General information

NPI: 1194720557
Provider Name (Legal Business Name): DAWN M BERGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E MAIL ROUTE MN 008-B213
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

5401 HIGH POINTE DR
HALTOM CITY TX
76137-2691
US

V. Phone/Fax

Practice location:
  • Phone: 682-459-4604
  • Fax:
Mailing address:
  • Phone: 682-459-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP121762
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: