Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 52367 | MN |
NPI | 1013171545 |
---|---|
Provider Name | Dr. Holly Lynn Schrupp Berg |
First Address | Bloomington, MN 55435-5435 |
Second Address | Bloomington, MN 55435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 08/06/2018 |