Individual
LEILA MARIE BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2275 S EAGLE RD STE 120, MERIDIAN, ID 83642-2620
(208) 514-2520
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6271988
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/07/2025
Last updated
01/13/2026
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