1811171390 NPI number — MS. GABRIELLE SUZANNE BERGMANN APRN, BC

Table of content: MS. GABRIELLE SUZANNE BERGMANN APRN, BC (NPI 1811171390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811171390 NPI number — MS. GABRIELLE SUZANNE BERGMANN APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGMANN
Provider First Name:
GABRIELLE
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811171390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIT 31550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
243815560151
Provider Business Mailing Address Fax Number:
243815560172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US EMBASSY KINSHASA
Provider Second Line Business Practice Location Address:
310 AVENUE DES AVIATEURS, GOMBE
Provider Business Practice Location Address City Name:
KINSHASA
Provider Business Practice Location Address State Name:
KINSHASA
Provider Business Practice Location Address Postal Code:
000
Provider Business Practice Location Address Country Code:
CD
Provider Business Practice Location Address Telephone Number:
243815560151
Provider Business Practice Location Address Fax Number:
243815560172
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024166508 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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