Healthcare Provider Details

I. General information

NPI: 1316717648
Provider Name (Legal Business Name): NATALIE NORTHUP BERGNER NAHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE BERGNER

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 LOMITA ST
SANTA FE NM
87505-8870
US

IV. Provider business mailing address

304 LOMITA ST
SANTA FE NM
87505-8870
US

V. Phone/Fax

Practice location:
  • Phone: 917-674-4155
  • Fax:
Mailing address:
  • Phone: 917-674-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number26028D
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1690265
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: