Provider Demographics
NPI:1235675620
Name:BERGER, KRISTEN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8946 N 12000E RD
Mailing Address - Street 2:
Mailing Address - City:GRANT PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60940
Mailing Address - Country:US
Mailing Address - Phone:708-519-0581
Mailing Address - Fax:
Practice Address - Street 1:8946 N 12000E RD
Practice Address - Street 2:
Practice Address - City:GRANT PARK
Practice Address - State:IL
Practice Address - Zip Code:60940-5092
Practice Address - Country:US
Practice Address - Phone:708-519-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered