Provider Demographics
NPI:1568569945
Name:BERG, LAURA MARIE (APRN,BC CNS MSN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BERG
Suffix:
Gender:F
Credentials:APRN,BC CNS MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 SAN JOAQUIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2914
Mailing Address - Country:US
Mailing Address - Phone:505-268-7303
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO AVENUE SE
Practice Address - Street 2:NMVAHCS (116) VA MEDICAL CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28544364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health