Individual
SHELLIE GERMAINE BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
970 LAKE ST, GREEN BAY, WI 54303-1866
(920) 265-4080
Mailing address
970 LAKE ST, GREEN BAY, WI 54303-1866
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321622-31
WI
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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