Provider Demographics
NPI:1750117743
Name:BERG, HANNAH SUMNYR (FNP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:SUMNYR
Last Name:BERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S FM 51 STE 107
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3646
Mailing Address - Country:US
Mailing Address - Phone:940-230-2580
Mailing Address - Fax:
Practice Address - Street 1:1705 S FM 51 STE 107
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3646
Practice Address - Country:US
Practice Address - Phone:258-094-0230
Practice Address - Fax:940-900-0575
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX851911163W00000X
TX1177520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse