Provider Demographics
NPI:1073023602
Name:BERGER, BRAD WESTON (RN)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:WESTON
Last Name:BERGER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7036
Mailing Address - Country:US
Mailing Address - Phone:920-279-1052
Mailing Address - Fax:
Practice Address - Street 1:2315 SHORE PRESERVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7785
Practice Address - Country:US
Practice Address - Phone:920-279-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167959-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse