Provider Demographics
NPI:1568857845
Name:BERGHOFF, REBECCA MARIE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:BERGHOFF
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:EBERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN- BSN
Mailing Address - Street 1:55 WEST WASHINGTON AVENUE
Mailing Address - Street 2:UNIT #54
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903
Mailing Address - Country:US
Mailing Address - Phone:509-594-6758
Mailing Address - Fax:
Practice Address - Street 1:55 WEST WASHINGTON AVENUE
Practice Address - Street 2:UNIT #54
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903
Practice Address - Country:US
Practice Address - Phone:509-594-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00056780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse