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General NPI Number Information
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NPI Number | 1306018148
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Entity Type | Individual
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Provider Name | DIANE E BERGERON NP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 1111 MEDICAL PLAZA DR 250
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3240
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Country | US
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Telephone | 281-296-8788
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Fax | 281-419-1291
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Provider Business Mailing Address
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Address Line | PO BOX 8307
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City | THE WOODLANDS
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State | TX
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Zip | 77387-8307
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Country | US
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Telephone | 281-296-8788
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Fax | 281-419-1291
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 626794
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License Number State | TX
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