MEDICARE: KRISTEN BERGER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	209015549	IL

General Provider Information

NPI Number	:	1235675620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN BERGER CRNA

Provider Business Mailing Address
First Line	:	8946 N 12000E RD
Second Line	:
City	:	GRANT PARK
State	:	IL
Zip	:	60940
Country	:	US
Telephone Number	:	708-519-0581
Fax Number	:

Provider Business Practice Location Address
First Line	:	8946 N 12000E RD
Second Line	:
City	:	GRANT PARK
State	:	IL
Zip	:	60940-5092
Country	:	US
Telephone Number	:	708-519-0581
Fax Number	:

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

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	10/02/2023

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