Individual
ABBY R BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71003337A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000805893
ANTHEM PROVIDER NUMBER
IN
05
—
201138970
—
IN
Enumeration date
02/22/2013
Last updated
11/26/2024
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