Provider Demographics
NPI:1679161467
Name:BJORGUM, ADRIENNE RAINA
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:RAINA
Last Name:BJORGUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661625
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95866-1625
Mailing Address - Country:US
Mailing Address - Phone:310-975-9230
Mailing Address - Fax:
Practice Address - Street 1:11485 C AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2701
Practice Address - Country:US
Practice Address - Phone:530-889-7159
Practice Address - Fax:530-889-7198
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator