Provider Demographics
NPI:1205421799
Name:BERG, PAULINE (LVN)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 BUNNY TRL
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6930
Mailing Address - Country:US
Mailing Address - Phone:254-553-8110
Mailing Address - Fax:254-553-8111
Practice Address - Street 1:5200 BUNNY TRL
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6930
Practice Address - Country:US
Practice Address - Phone:254-553-8110
Practice Address - Fax:254-553-8111
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110135164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse