Provider Demographics
NPI:1811908163
Name:BERG, NANCY CAROL (PAC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CAROL
Last Name:BERG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:CAROL
Other - Last Name:HINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:8020 LEE DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-2078
Mailing Address - Country:US
Mailing Address - Phone:720-641-4710
Mailing Address - Fax:720-996-8800
Practice Address - Street 1:8020 LEE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-2078
Practice Address - Country:US
Practice Address - Phone:720-641-4710
Practice Address - Fax:720-996-8800
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1183363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C177308Medicare PIN
COS66829Medicare UPIN