Provider Demographics
NPI:1992218762
Name:BERGSTROM, MARICELA (MSN APRN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARICELA
Middle Name:
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:MSN APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 BUSKIRK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-6900
Mailing Address - Country:US
Mailing Address - Phone:888-380-0988
Mailing Address - Fax:289-236-3022
Practice Address - Street 1:823 CONGRESS AVE STE 150-518
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2405
Practice Address - Country:US
Practice Address - Phone:888-380-0988
Practice Address - Fax:289-236-3022
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily