MEDICARE: MS. BERGEN CHRISTINE VARDELL WHNP, CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	31936.1243	WY
2	367A00000X	Advanced Practice Midwife	AP115623	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942359757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERGEN CHRISTINE VARDELL WHNP, CNM

Provider Business Mailing Address
First Line	:	4515 SETON CENTER PKWY STE 215
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12174 N MOPAC EXPY STE A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2910
Country	:	US
Telephone Number	:	512-994-2662
Fax Number	:	512-406-6202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/19/2017

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