Provider Demographics
NPI:1578078465
Name:BERGER, HEATHER (CST)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 N CURTIS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1348
Mailing Address - Country:US
Mailing Address - Phone:208-367-7463
Mailing Address - Fax:208-367-7507
Practice Address - Street 1:1075 N CURTIS RD STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1348
Practice Address - Country:US
Practice Address - Phone:208-367-7463
Practice Address - Fax:208-367-7507
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID141731OtherCST CERTIFICATION