Provider Demographics
NPI:1295280790
Name:BERG, KRISTINA LEE (DNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEE
Last Name:BERG
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2009
Mailing Address - Country:US
Mailing Address - Phone:618-553-8684
Mailing Address - Fax:
Practice Address - Street 1:401 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2009
Practice Address - Country:US
Practice Address - Phone:618-553-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily