Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 266302 | AZ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 339705 | NY |
NPI | 1003297599 |
---|---|
Provider Name | Ashleigh Berger |
First Address | Phoenix, AZ 85020-2455 |
Second Address | Latham, NY 12110-1074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2015 |
Last Update Date | 10/12/2021 |