Provider Demographics
NPI:1831546423
Name:BERG, DANIELLE ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:BERG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ELIZABETH
Other - Last Name:HAMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3508 N BELT HWY APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1345
Mailing Address - Country:US
Mailing Address - Phone:816-205-4123
Mailing Address - Fax:816-205-4129
Practice Address - Street 1:3508 N BELT HWY APT A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1345
Practice Address - Country:US
Practice Address - Phone:816-205-4123
Practice Address - Fax:816-205-4129
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77273363LF0000X
MO2016019532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201213480BMedicaid