Provider Demographics
NPI:1225169261
Name:BERG, ANGELA CHRISTINE (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:BERG
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:SCHMUECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5303 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3800
Mailing Address - Country:US
Mailing Address - Phone:517-887-4467
Mailing Address - Fax:517-244-7174
Practice Address - Street 1:102 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1760
Practice Address - Country:US
Practice Address - Phone:517-244-8041
Practice Address - Fax:517-244-7189
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAB190660OtherBCBS PIN AT BEDHD