=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811211071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA BERGE FNP-BC, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2010
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 S RIVER RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-265-8014
-----------------------------------------------------
Fax | 603-267-3970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DOROTHYS WAY
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-493-1132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 034726-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------