Healthcare Provider Details

I. General information

NPI: 1023332335
Provider Name (Legal Business Name): LOANDRA BERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 N 500 W
PROVO UT
84604-3322
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-4417
  • Fax:
Mailing address:
  • Phone: 801-357-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5302161-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: