Active NPI
Randi Marie Berg, ARNP
- Pediatric Nurse Practitioner
- Tacoma, WA
National Provider Identifier
1023069184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- AP30001161
- Practice address
- 9040 Reid St
Tacoma, WA 98431-1100 - Phone
- (253) 968-2315
- NPI assigned
- May 13, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | AP30001161 | WA | Primary |
Addresses
Primary practice location
9040 Reid St
Tacoma, WA 98431-1100
Mailing address
4109 74TH Ave SE
Olympia, WA 98501-9602
Phone (360) 491-0529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP30001161 | WA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023069184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4109 74TH AVE SE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985019602",
"telephone_number": "360-491-0529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 REID ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984311100",
"telephone_number": "253-968-2315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "RANDI",
"middle_name": "MARIE",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "WA",
"license": "AP30001161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.