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NPI Code Detail

MEDICARE: MRS. LISA DIANA BERGH

MEDICARE: MRS. LISA DIANA BERGH
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
1367500000XCertified Registered Nurse AnesthetistRN9336837FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235759168
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA DIANA BERGH
Provider Business Mailing Address
First Line : 18382 FERN RD
Second Line :
City : FORT MYERS
State : FL
Zip : 33967-3242
Country : US
Telephone Number : 239-250-0007
Fax Number :
Provider Business Practice Location Address
First Line : 9981 S HEALTHPARK DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3620
Country : US
Telephone Number : 239-343-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2020
Last Update Date : 04/21/2020

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