Provider Demographics
NPI:1356956619
Name:BERGHOLTZ, ANDREA ILENE (MSN, RN, CHPN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ILENE
Last Name:BERGHOLTZ
Suffix:
Gender:F
Credentials:MSN, RN, CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:72 MOODY CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-371-9988
Mailing Address - Fax:805-371-9987
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-371-9988
Practice Address - Fax:805-371-9987
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA781694163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health