Individual
DIANE E BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1111 MEDICAL PLAZA DR, 250, THE WOODLANDS, TX 77380-3240
(281) 296-8788
(281) 419-1291
Mailing address
PO BOX 8307, THE WOODLANDS, TX 77387-8307
(281) 296-8788
(281) 419-1291
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
626794
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154240902
—
TX
05
—
193009102
—
TX
Enumeration date
04/01/2008
Last updated
07/06/2010
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