Provider Demographics
NPI:1184774036
Name:BERGE, LORRI JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:JEAN
Last Name:BERGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:JEAN
Other - Last Name:BERGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 4TH AVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98164-1008
Mailing Address - Country:US
Mailing Address - Phone:425-256-0041
Mailing Address - Fax:206-749-4339
Practice Address - Street 1:900 4TH AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98164-1008
Practice Address - Country:US
Practice Address - Phone:425-256-0041
Practice Address - Fax:206-749-4339
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006050363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9632498Medicaid
WA9632498Medicaid
WAP47215Medicare UPIN