Individual
MARY BETH VALEK BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
14121 PARKE LONG CT, SUITE 201, CHANTILLY, VA 20151-1647
(440) 503-8519
Mailing address
14121 PARKE LONG CT, SUITE 201, CHANTILLY, VA 20151-1647
(440) 503-8519
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
APRN.CNP.15082
OH
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN.CNP.15082
OH
363LP2300X
Primary Care Nurse Practitioner
APRN.CNP.15082
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0103279
—
OH
Enumeration date
05/06/2014
Last updated
04/18/2017
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