Provider Demographics
NPI:1679092639
Name:BERGSTROM, BARBARA (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4061
Mailing Address - Country:US
Mailing Address - Phone:530-243-3154
Mailing Address - Fax:
Practice Address - Street 1:1900 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1802
Practice Address - Country:US
Practice Address - Phone:530-225-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217853163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant