Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 65386 | MN |
N | 2080N0001X | Neonatal-Perinatal Doctor | DO-04888 | IA |
NPI | 1124464771 |
---|---|
Provider Name | Jennifer Noel Berger |
First Address | Minneapolis, MN 55404-4518 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 15/05/2019 |