| NPI | 1962486969 |
|---|---|
| Former Name | STACEY LEE BERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0348) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0537) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2014-09-18 |