Provider Demographics
NPI:1164218681
Name:BERG, CHRISTINE D (RDN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:BERG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 THE HAMPTONS LN
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5901
Mailing Address - Country:US
Mailing Address - Phone:314-680-9088
Mailing Address - Fax:
Practice Address - Street 1:728 THE HAMPTONS LN
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-5901
Practice Address - Country:US
Practice Address - Phone:314-680-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO86083915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered