Berg, Jill C.

Berg, Jill C. is an individual health care provider with primary practice located at 7916 W Jefferson Blvd , Fort Wayne IN 46804-4140. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Berg, Jill C. can be contacted via phone (260) 432-2297.

Contact Information

Primary practice address
7916 W Jefferson Blvd Fort Wayne IN 46804-4140
Phone: (260) 432-2297
Fax: (260) 434-6433
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71001258A Indiana

Profile Details

NPI number 1447219951
LBN Legal business name Berg, Jill C.
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 22nd, 2006
Last updated Dec 18th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447219951 NPPES
Other 500022462 RAILROAD
Other 000000289365 RAILROAD
MEDICAID 200353910 RAILROAD
MEDICAID 2454348 RAILROAD

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