Healthcare Provider Details

I. General information

NPI: 1033823497
Provider Name (Legal Business Name): MICHELLE BERGER APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 ZUNI RD SE STE 11
ALBUQUERQUE NM
87108-2935
US

IV. Provider business mailing address

6501 SAN ANTONIO DR NE UNIT 201
ALBUQUERQUE NM
87109-4138
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-6849
  • Fax:
Mailing address:
  • Phone: 505-280-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: