Individual
BREANNA K BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
212 E CENTRAL AVE, STE. 440, SPOKANE, WA 99208-6291
(509) 252-9602
(509) 227-7070
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
175
AK
133V00000X
Registered Dietitian
D-530
ID
133V00000X
Registered Dietitian
Primary
DI60595970
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DT9813
—
AK
Enumeration date
03/13/2007
Last updated
03/24/2017
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