Healthcare Provider Details

I. General information

NPI: 1679499941
Provider Name (Legal Business Name): ERIN BERGQUIST PHD,MPH,RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26517 19TH ST S
NEVADA IA
50201-7587
US

IV. Provider business mailing address

26517 19TH ST S
NEVADA IA
50201-7587
US

V. Phone/Fax

Practice location:
  • Phone: 515-707-8314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01577
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: