MEDICARE: LEA BERGER RN

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	163WE0003X	Emergency Registered Nurse	R54609	ND

General Provider Information

NPI Number	:	1982445656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA BERGER RN

Provider Business Mailing Address
First Line	:	3721 E PRINCETON AVE
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7502
Country	:	US
Telephone Number	:	701-390-3517
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 STANDING ROCK AVE
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-8528
Country	:	US
Telephone Number	:	701-854-8222
Fax Number	:

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

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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