Provider Demographics
NPI:1568878072
Name:BERG, JESSICA ELIN (APRN/CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIN
Last Name:BERG
Suffix:
Gender:F
Credentials:APRN/CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELIN
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN/CNP
Mailing Address - Street 1:523 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-828-2861
Mailing Address - Fax:218-828-3126
Practice Address - Street 1:13050 ISLE DRIVE
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-454-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR182725-3363LF0000X
MN3700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN182725-3OtherMN BOARD OF NURSING