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General NPI Number Information
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NPI Number | 1205312006
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Entity Type | Individual
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Provider Name | MIRIAM R. BERG APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2018
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 6024 HOOVER RD STE A
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City | GROVE CITY
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State | OH
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Zip | 43123-8133
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Country | US
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Telephone | 614-627-1880
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Fax | 614-539-4610
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Provider Business Mailing Address
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Address Line | 775 W BROAD ST STE 200
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City | COLUMBUS
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State | OH
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Zip | 43222-1471
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Country | US
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Telephone | 614-627-1610
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Fax | 614-228-5040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.023750
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License Number State | OH
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