Healthcare Provider Details

I. General information

NPI: 1679092639
Provider Name (Legal Business Name): BARBARA BERGSTROM RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RAILROAD AVE
REDDING CA
96001-1802
US

IV. Provider business mailing address

1052 RIVIERA DR
REDDING CA
96001-4061
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-7485
  • Fax:
Mailing address:
  • Phone: 530-243-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number217853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: