Provider Demographics
NPI:1336516590
Name:BERG, LAURIE A (APN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:BERG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-575-5000
Mailing Address - Fax:
Practice Address - Street 1:911 N ELM ST STE 102
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3640
Practice Address - Country:US
Practice Address - Phone:630-495-9356
Practice Address - Fax:630-495-9357
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily