Individual
DESTENY GRACE BERGDOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
811 N 13TH ST, PHOENIX, AZ 85006-3400
(602) 257-3865
Mailing address
1817 N 7TH ST, PHOENIX, AZ 85006-2133
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
287895
AZ
Other
Enumeration date
08/20/2024
Last updated
08/20/2024
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