Provider Demographics
NPI:1437762317
Name:BERG, NANCY LYNN (CPSS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:BERG
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3533
Mailing Address - Country:US
Mailing Address - Phone:985-634-6873
Mailing Address - Fax:
Practice Address - Street 1:900 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3533
Practice Address - Country:US
Practice Address - Phone:985-634-6873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist