Provider Demographics
NPI:1336883446
Name:BERGER, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:12079 COUNTY ROAD 13
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9620
Mailing Address - Country:US
Mailing Address - Phone:419-204-4605
Mailing Address - Fax:
Practice Address - Street 1:12079 COUNTY ROAD 13
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9620
Practice Address - Country:US
Practice Address - Phone:419-204-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN246554163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704323820OtherRN
IN28264017AOtherRN
OH246554OtherRN