Provider Demographics
NPI:1760915193
Name:BERGER, JENNIFER CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:LEGINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1313 SOUTH 101ST STREET APT. 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:785-221-0349
Mailing Address - Fax:
Practice Address - Street 1:42ND AND EMILE STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198
Practice Address - Country:US
Practice Address - Phone:402-559-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE34963390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program