| NPI | 1831399807 |
|---|---|
| Former Name | TANYA MAE BERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OR 200750080NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 200750080NP) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2012-03-08 |