Provider Demographics
NPI:1033240098
Name:BERG, VICKI LYNNE (RN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNNE
Last Name:BERG
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:PO BOX 137 701 LEWISTON ST
Mailing Address - Street 2:ST. MARY'S HOSPITAL & CLINICS
Mailing Address - City:COTTONWOOD
Mailing Address - State:ID
Mailing Address - Zip Code:83522-0137
Mailing Address - Country:US
Mailing Address - Phone:208-962-3267
Mailing Address - Fax:208-962-2313
Practice Address - Street 1:701 LEWISTON ST.
Practice Address - Street 2:ST. MARY'S HOSPITAL & CLINICS
Practice Address - City:COTTONWOOD
Practice Address - State:ID
Practice Address - Zip Code:83522-0137
Practice Address - Country:US
Practice Address - Phone:208-962-3267
Practice Address - Fax:208-962-2313
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR59893163WD0400X
IDN-19516163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator