Healthcare Provider Details

I. General information

NPI: 1013009570
Provider Name (Legal Business Name): ELEANOR K BERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 28/55 GRANT MEMORIAL DRIVE GRANT MEMORIAL HOSPITAL
PETERSBURG WV
26847
US

IV. Provider business mailing address

ROUTE 28/55 GRANT MEMORIAL DRIVE GRANT MEMORIAL HOSPITAL
PETERSBURG WV
26847
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-1026
  • Fax:
Mailing address:
  • Phone: 304-257-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number31685
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31685
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: