Provider Demographics
NPI:1629176763
Name:BERG, NANCY CHRISTINE (CNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CHRISTINE
Last Name:BERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2533
Mailing Address - Country:US
Mailing Address - Phone:651-290-0133
Mailing Address - Fax:
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2533
Practice Address - Country:US
Practice Address - Phone:651-290-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRNRO764812363LA2200X
MNANCC20233321363LA2200X
MNCNP0778363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43993300OtherWISCONSIN MEDICAID
MN255460700Medicaid
WI43993300OtherWISCONSIN MEDICAID
MN500003244Medicare ID - Type Unspecified