=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982551909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH BERG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 LIBERTY BLVD STE 130
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19355-1486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-318-2268
-----------------------------------------------------
Fax | 844-820-9641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 RALSTON AVE
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-614-2774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | RN300110L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------