Individual
MARSHALL BARR BERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4605 E ELWOOD ST STE 500, PHOENIX, AZ 85040-1978
(480) 256-1518
(480) 304-3446
Mailing address
1526 E BEACON DR, GILBERT, AZ 85234-2674
(480) 282-2011
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN192249
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
269219
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269219
ARIZONA NURSING BOARD
AZ
Enumeration date
10/12/2021
Last updated
02/17/2022
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