Healthcare Provider Details

I. General information

NPI: 1144587726
Provider Name (Legal Business Name): LINDA MARIE BERGMAN RN,WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST STE 501
VAN NUYS CA
91405-3600
US

IV. Provider business mailing address

15243 VANOWEN ST STE 501
VAN NUYS CA
91405-3600
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-2330
  • Fax:
Mailing address:
  • Phone: 818-781-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN449968
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP7610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: