Provider Demographics
NPI:1548908650
Name:BERGER, ELIZABETH ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:BERGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6345 E TOWER CASTLE LOOP
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4930
Mailing Address - Country:US
Mailing Address - Phone:571-213-0660
Mailing Address - Fax:
Practice Address - Street 1:2275 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8012
Practice Address - Country:US
Practice Address - Phone:208-900-3434
Practice Address - Fax:208-701-6272
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID60595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine