| Doctor Name: | MS. THERESA KIMBERLEY MALMON-BERG |
| NPI Number: | 1013139021 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.N., C.N.P. |
| License Number: | NP05937 |
| Business Practice Address: | 1740 Cleveland Rd Wooster, OH - 446912204 |
| Business Phone Number: | 3302874500 |
| Business Fax Number: | |
| Mailing Address: | 907 Forest Dr., WOOSTER |
| State: | OH |
| Postal Code: | 44691 |
| Phone Number: | 3302624501 |
| Fax Number: | |
| NPI Enumeration Date: | 05/02/2007 |
| NPI Last Update Date: | 07/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP05937 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |