Provider Demographics
NPI:1023157930
Name:BERG-GAITHER, JODI L (CRNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:BERG-GAITHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:410-225-8961
Mailing Address - Fax:410-462-5889
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 405
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-225-8961
Practice Address - Fax:410-462-5889
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily