Provider Demographics
NPI:1871254870
Name:BERGH, DONNA LOUISE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:BERGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 E HASKINS CT
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9503
Mailing Address - Country:US
Mailing Address - Phone:760-525-5420
Mailing Address - Fax:
Practice Address - Street 1:6045 E HASKINS CT
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9503
Practice Address - Country:US
Practice Address - Phone:760-525-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ234978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse