Individual
LENORA MARIE BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 525-2668
Mailing address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 525-2668
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
549983
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183193502
—
TX
01
—
750818167015
TRICARE
TX
01
—
8J5340
BCBS
TX
Enumeration date
10/20/2006
Last updated
10/21/2008
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