Basic Information
| Provider Information | |||||||||
| NPI: | 1013009570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERG | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | ROUTE 28/55 GRANT MEMORIAL DRIVE | ||||||||
| Address2: | GRANT MEMORIAL HOSPITAL | ||||||||
| City: | PETERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042571026 | ||||||||
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| Practice Location | |||||||||
| Address1: | ROUTE 28/55 GRANT MEMORIAL DRIVE | ||||||||
| Address2: | GRANT MEMORIAL HOSPITAL | ||||||||
| City: | PETERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042571026 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 31685 | WV | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | 31685 | WV | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.