1760493829 NPI number — KATHERINE JOAN BERGER DPM

Table of content: KATHERINE JOAN BERGER DPM (NPI 1760493829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760493829 NPI number — KATHERINE JOAN BERGER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGER
Provider First Name:
KATHERINE
Provider Middle Name:
JOAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760493829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 O STREET
Provider Second Line Business Mailing Address:
KATHERINE J BERGER DPM
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-474-4766
Provider Business Mailing Address Fax Number:
402-474-5957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 O STREET
Provider Second Line Business Practice Location Address:
KATHERINE J BERGER DPM
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-474-4766
Provider Business Practice Location Address Fax Number:
402-474-5957
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  219 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480009767 . This is a "RR MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com