Individual
CAROL J BERGBOWER
Active
Individual
CAROL J BERGBOWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041212985
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01732004
BC/BS
IL
01
—
020354300
BLACK LUNG
IL
01
—
041212985
STATE LICENSE
IL
01
—
200009980
IRS TAX ID
IL
01
—
540347
HEALTHLINK
IL
01
—
DA2630
RR MEDICARE GROUP
IL
01
—
P00042146
RR MEDICARE PIN
IL
Enumeration date
06/09/2006
Last updated
10/29/2020
Update your record
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