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General NPI Number Information
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NPI Number | 1417234360
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Entity Type | Individual
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Provider Name | TERRI DENISE BERGER CPNP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 3525 PELANDALE AVE
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City | MODESTO
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State | CA
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Zip | 95356-9781
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Country | US
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Telephone | 559-572-3880
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Fax | 559-572-3349
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Provider Business Mailing Address
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Address Line | 3525 PELANDALE AVE
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City | MODESTO
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State | CA
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Zip | 95356-9781
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Country | US
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Telephone | 559-572-3880
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Fax | 559-572-3349
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | LIC#438822CERT#11720
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 11720
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License Number State | CA
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