Provider Demographics
NPI:1841638467
Name:BERGE, RITA A (RDH)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:A
Last Name:BERGE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4873 IRISH LN
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5615
Mailing Address - Country:US
Mailing Address - Phone:608-332-2309
Mailing Address - Fax:
Practice Address - Street 1:4873 IRISH LN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5615
Practice Address - Country:US
Practice Address - Phone:608-332-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI375816124Q00000X
WI2013254P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No374U00000XNursing Service Related ProvidersHome Health Aide