Provider Demographics
NPI:1194218305
Name:BERGIN, MARY PAT (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:BERGIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 39TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1601
Mailing Address - Country:US
Mailing Address - Phone:253-952-0304
Mailing Address - Fax:
Practice Address - Street 1:32901 WEYERHAEUSER WAY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98001-9348
Practice Address - Country:US
Practice Address - Phone:253-924-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00102745163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00102745OtherRN