Provider Demographics
NPI:1396036877
Name:BERG, CHERYL DAUNE (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DAUNE
Last Name:BERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 21ST ST NW
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-0789
Mailing Address - Country:US
Mailing Address - Phone:951-897-1011
Mailing Address - Fax:
Practice Address - Street 1:2401 CENTRE AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4180
Practice Address - Country:US
Practice Address - Phone:505-248-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR57273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse