Provider Demographics
NPI:1790769552
Name:BERG, ANN-MARIE H (CPNP)
Entity Type:Individual
Prefix:MS
First Name:ANN-MARIE
Middle Name:H
Last Name:BERG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:411 10TH ST SE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2442
Mailing Address - Country:US
Mailing Address - Phone:319-363-3600
Mailing Address - Fax:319-363-9971
Practice Address - Street 1:411 10TH ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2442
Practice Address - Country:US
Practice Address - Phone:319-363-3600
Practice Address - Fax:319-363-9971
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAC-095353363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics