Healthcare Provider Details

I. General information

NPI: 1396634218
Provider Name (Legal Business Name): LAUREN ALESSANDRA BERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

IV. Provider business mailing address

718 E 40TH AVE
SPOKANE WA
99203-2904
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-2461
  • Fax:
Mailing address:
  • Phone: 509-218-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.RN.61378052
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: