Provider Demographics
NPI:1497304836
Name:BERG, ANNETTE B
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:B
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W CLEARBROOK DR APT 20
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2381
Mailing Address - Country:US
Mailing Address - Phone:360-820-8264
Mailing Address - Fax:
Practice Address - Street 1:216 MARINGO RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1528
Practice Address - Country:US
Practice Address - Phone:509-350-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide