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General NPI Number Information
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NPI Number | 1952744815
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Entity Type | Individual
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Provider Name | JESSICA MARIE BERGLUND RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 640 WALNUT ST 1ST FLOOR- DIABETES MANAGEMENT SERVICES
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City | READING
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State | PA
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Zip | 19601-3504
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Country | US
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Telephone | 610-378-2031
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Fax | 610-378-2543
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Provider Business Mailing Address
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Address Line | 640 WALNUT ST 1ST FLOOR- DIABETES MANAGEMENT SERVICES
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City | READING
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State | PA
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Zip | 19601-3504
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Country | US
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Telephone | 610-378-2031
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Fax | 610-378-2543
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DN004742
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1030122
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License Number State | PA
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