Provider Demographics
NPI:1841946290
Name:BERGRUD, KIMBERLY (CD(DONA))
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BERGRUD
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 N POTLATCH DR
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1341 N POTLATCH DR
Practice Address - Street 2:
Practice Address - City:HOODSPORT
Practice Address - State:WA
Practice Address - Zip Code:98548
Practice Address - Country:US
Practice Address - Phone:253-228-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603578990374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula