Healthcare Provider Details

I. General information

NPI: 1831403799
Provider Name (Legal Business Name): CHRISTINE CAROL BERGERON APRN,NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 NELSON RD
LAKE CHARLES LA
70605-4118
US

IV. Provider business mailing address

4200 NELSON RD
LAKE CHARLES LA
70605-4118
US

V. Phone/Fax

Practice location:
  • Phone: 337-475-4181
  • Fax: 337-475-4713
Mailing address:
  • Phone: 337-475-4181
  • Fax: 337-475-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN 078671/AP05202
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: