Provider Demographics
NPI:1205312006
Name:BERG, MIRIAM R (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:R
Last Name:BERG
Suffix:
Gender:F
Credentials:APRN-CNP
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Mailing Address - Street 1:775 W BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1471
Mailing Address - Country:US
Mailing Address - Phone:614-627-1610
Mailing Address - Fax:614-228-5040
Practice Address - Street 1:6024 HOOVER RD STE A
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8133
Practice Address - Country:US
Practice Address - Phone:614-627-1880
Practice Address - Fax:614-539-4610
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2025-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023750363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner