Healthcare Provider Details

I. General information

NPI: 1164201323
Provider Name (Legal Business Name): OLIVIA ROSE BERGANDY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 TUCKER RD
DARTMOUTH MA
02747-3145
US

IV. Provider business mailing address

1281 TUCKER RD
DARTMOUTH MA
02747-3145
US

V. Phone/Fax

Practice location:
  • Phone: 401-256-0354
  • Fax:
Mailing address:
  • Phone: 401-256-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2318029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: