Healthcare Provider Details

I. General information

NPI: 1619908811
Provider Name (Legal Business Name): CHRISTOPHER RONALD BERGE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 HUFFMAN MILL RD STE 130
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

PO BOX 890195
CHARLOTTE NC
28289-0195
US

V. Phone/Fax

Practice location:
  • Phone: 336-438-1060
  • Fax:
Mailing address:
  • Phone: 336-547-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number900349
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: