Healthcare Provider Details

I. General information

NPI: 1609098672
Provider Name (Legal Business Name): DOROTHY ANN BERGERON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GEARY BLVD
SAN FRANCISCO CA
94115
US

IV. Provider business mailing address

350 SAINT JOSEPHS AVE
SAN FRANCISCO CA
94115-3255
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-4129
  • Fax:
Mailing address:
  • Phone: 415-833-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number266568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: