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General NPI Number Information
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NPI Number | 1467126276
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Entity Type | Individual
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Provider Name | DEANNE BERGH NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 401 W POPLAR ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-2846
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Country | US
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Telephone | 509-897-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 380 RESERVE WAY
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City | WALLA WALLA
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State | WA
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Zip | 99362-0700
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Country | US
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Telephone | 509-956-6350
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61201378
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License Number State | WA
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