Berg, John Dennis

Berg, John Dennis is an sole proprietor health care provider with primary practice located at 4936 Ormond Beach Ct , Oshkosh WI 54904-9342. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Berg, John Dennis can be contacted via phone (920) 410-0472.

Contact Information

Primary practice address
4936 Ormond Beach Ct Oshkosh WI 54904-9342
Phone: (920) 410-0472
Fax: (920) 235-8915
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 67892-030 Wisconsin

Profile Details

NPI number 1407838824
LBN Legal business name Berg, John Dennis
Credentials CRNA APNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 20th, 2005
Last updated Jul 8th, 2007 - about 17 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 1407838824 NPPES
Wisconsin Other 67892-030 NURSING LICENSE
Wisconsin Other 383-033 NURSING LICENSE
Wisconsin Other 31946 NURSING LICENSE
Wisconsin MEDICAID 43299100 NURSING LICENSE

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