Provider Demographics
NPI:1902878523
Name:BERG, MOLLY REBECCA (CNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:REBECCA
Last Name:BERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S CLIFF AVE
Practice Address - Street 2:STE 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1063
Practice Address - Country:US
Practice Address - Phone:605-322-8937
Practice Address - Fax:605-322-8938
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SDCP000444363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN924114229808OtherPRIMEWEST
SD9243925OtherDAKOTACARE
IA0503706Medicaid
SD2387950OtherARAZ/ AMERICA'S PPO
SD370624200OtherDEPT OF LABOR
SDHP55698OtherHEALTHPARTNERS
NE10025040700Medicaid
SD6828250Medicaid
SD0705288OtherMEDICA
MN263P6DAOtherCC SYSTEMS/ BLUE PLUS
SD6828252Medicaid
SD283761045257OtherPREFERRED ONE
SD57105AD04OtherWPS TRICARE
MN263P6DAOtherBLUE CROSS
SD4994372OtherBLUE CROSS
MN122586300Medicaid
SD248008OtherMIDLANDS CHOICE
NE10025040700Medicaid
SD6828250Medicaid
SDS103081Medicare PIN