Active NPI
Michelle Lee Berg, DNP FNP-C
- Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1568208726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 11747
- Practice address
- 1 Veterans Dr
Minneapolis, MN 55417-2309 - Phone
- (612) 725-2000
- NPI assigned
- Jul 6, 2024
- Last updated
- Jul 6, 2024
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 11747 | MN | Primary |
Addresses
Primary practice location
1 Veterans Dr
Minneapolis, MN 55417-2309
Mailing address
505 Winkler TRL N
Cologne, MN 55322-7503
Phone (503) 701-8961
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251111003439 | MN | Order and Referring Only - Nurse Practitioner | 4587155171 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11747 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720224000000",
"number": "1568208726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 WINKLER TRL N",
"city": "COLOGNE",
"state": "MN",
"postal_code": "553227503",
"telephone_number": "503-701-8961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 VETERANS DR",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554172309",
"telephone_number": "612-725-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "MICHELLE",
"middle_name": "LEE",
"credential": "DNP FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-06",
"last_updated": "2024-07-06",
"certification_date": "2024-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "11747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.