Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 31685 | WV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 31685 | WV |
NPI | 1013009570 |
---|---|
Provider Name | Eleanor K Berg |
First Address | Petersburg, WV 26847 |
Second Address | Petersburg, WV 26847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |