Provider Demographics
NPI:1508218082
Name:BERGLUND, CATHERINE (LVN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANNETTE
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:120 PEBBLE BEACH CT.
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OR
Mailing Address - Zip Code:97495
Mailing Address - Country:US
Mailing Address - Phone:301-260-0042
Mailing Address - Fax:
Practice Address - Street 1:120 PEBBLE BEACH CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OR
Practice Address - Zip Code:97495
Practice Address - Country:US
Practice Address - Phone:301-260-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 134942164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse