Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 136468 | MO |
NPI | 1003140328 |
---|---|
Provider Name | Carol Berger |
First Address | Saint Peters, MO 63376-1345 |
Second Address | Saint Peters, MO 63376-6337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2009 |
Last Update Date | 23/02/2021 |