Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 34553 | IA |
N | 207KA0200X | Allergist | 34553 | IA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 34553 | IA |
NPI | 1063492361 |
---|---|
Provider Name | Dr. Jennifer K Berge |
First Address | West Burlington, IA 52655-1691 |
Second Address | West Burlington, IA 52655-1691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0260893 | (05) | IA |
06724 | WELLMARK GROUP # (01) | IA |
49542 | WELLMARK INDIVIDUAL # (01) | IA |
H45102 | (02) |