Provider Demographics
NPI:1801069422
Name:BERG, JULIE ANN (CNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 SALLY CIR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-4613
Mailing Address - Country:US
Mailing Address - Phone:330-990-3102
Mailing Address - Fax:
Practice Address - Street 1:673 SALLY CIR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-4613
Practice Address - Country:US
Practice Address - Phone:330-990-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health