Doctor Name: | BRENDA BERGHOLM |
NPI Number: | 1548493521 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, ACNS-BC |
License Number: | CNS-47A |
Business Practice Address: | 300 S 3rd W Soda Springs, ID - 832761559 |
Business Phone Number: | 2085473341 |
Business Fax Number: | 2085472790 |
Mailing Address: | 300 S 3rd W, SODA SPRINGS |
State: | ID |
Postal Code: | 832761559 |
Phone Number: | 2085473341 |
Fax Number: | 2085472790 |
NPI Enumeration Date: | 08/25/2009 |
NPI Last Update Date: | 08/25/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SA2200X |
License Number: | CNS-47A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |