Provider Demographics
NPI:1760416663
Name:BERG, LAWRENCE R (ENP)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:R
Last Name:BERG
Suffix:
Gender:M
Credentials:ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18514 MELLOWGROVE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4062
Mailing Address - Country:US
Mailing Address - Phone:281-703-6031
Mailing Address - Fax:
Practice Address - Street 1:10130 LOUETTA RD STE L
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2118
Practice Address - Country:US
Practice Address - Phone:346-808-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112512363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care