Healthcare Provider Details

I. General information

NPI: 1194218305
Provider Name (Legal Business Name): MARY PAT BERGIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32901 WEYERHAEUSER WAY S
FEDERAL WAY WA
98001-9348
US

IV. Provider business mailing address

6021 39TH AVE SW
SEATTLE WA
98136-1601
US

V. Phone/Fax

Practice location:
  • Phone: 253-924-2833
  • Fax:
Mailing address:
  • Phone: 253-952-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN00102745
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: