Provider Demographics
NPI:1093415846
Name:BERGER, JOANNA M
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:BERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-6006
Mailing Address - Country:US
Mailing Address - Phone:701-350-0574
Mailing Address - Fax:
Practice Address - Street 1:1615 AVENUE A
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-6006
Practice Address - Country:US
Practice Address - Phone:701-350-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker