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General NPI Number Information
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NPI Number | 1841638467
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Entity Type | Individual
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Provider Name | RITA A BERGE RDH
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Gender | Female
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 4873 IRISH LN
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City | FITCHBURG
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State | WI
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Zip | 53711-5615
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Country | US
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Telephone | 608-332-2309
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Fax |
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Provider Business Mailing Address
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Address Line | 4873 IRISH LN
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City | FITCHBURG
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State | WI
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Zip | 53711-5615
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Country | US
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Telephone | 608-332-2309
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 375816
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 2013254P
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License Number State | WI
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