Provider Demographics
NPI:1417234360
Name:BERGER, TERRI DENISE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:DENISE
Last Name:BERGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:DENISE
Other - Last Name:DAVIS-MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:3525 PELANDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9781
Mailing Address - Country:US
Mailing Address - Phone:559-572-3880
Mailing Address - Fax:559-572-3349
Practice Address - Street 1:3525 PELANDALE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9781
Practice Address - Country:US
Practice Address - Phone:559-572-3880
Practice Address - Fax:559-572-3349
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALIC#438822CERT#11720163WP0200X
CA11720363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics