Healthcare Provider Details

I. General information

NPI: 1891503538
Provider Name (Legal Business Name): KATHRYN GRACE BERGAMESCA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VICTORIA ST # VB360A
PITTSBURGH PA
15213-2543
US

IV. Provider business mailing address

2695 S WATER ST APT 739
PITTSBURGH PA
15203-4025
US

V. Phone/Fax

Practice location:
  • Phone: 888-747-0794
  • Fax:
Mailing address:
  • Phone: 703-627-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number347378
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: