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Individual

JILL C. BERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP-C

Contact information

Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 434-6433
Mailing address
6920 POINTE INVERNESS WAY STE 200, MEDPARTNERS, ATTN: BARB COPELAND, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001258A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000289365
ANTHEM
IN
05
200353910
IN
05
2454348
OH
01
500022462
RAILROAD
Enumeration date
03/22/2006
Last updated
12/18/2016
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