Healthcare Provider Details

I. General information

NPI: 1437203932
Provider Name (Legal Business Name): RONNI S BERGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TALLMAN AVE NW ANNEX 1
SEATTLE WA
98107-3932
US

IV. Provider business mailing address

5300 TALLMAN AVE NW ANNEX 1
SEATTLE WA
98107-3932
US

V. Phone/Fax

Practice location:
  • Phone: 206-781-6055
  • Fax:
Mailing address:
  • Phone: 206-781-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00090478
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: