MEDICARE: MS. BARBARA J. BERGES RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	RN.316283	OH

General Provider Information

NPI Number	:	1053528323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA J. BERGES RN, IBCLC

Provider Business Mailing Address
First Line	:	4339 MIDDLE RIDGE RD
Second Line	:
City	:	PERRY
State	:	OH
Zip	:	44081-9729
Country	:	US
Telephone Number	:	440-259-3293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4339 MIDDLE RIDGE RD
Second Line	:
City	:	PERRY
State	:	OH
Zip	:	44081-9729
Country	:	US
Telephone Number	:	440-259-3293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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