Individual
BRENDA BERGHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, ACNS-BC
Contact information
Practice address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Mailing address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
CNS-47A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNS-47A
IDAHO STATE LICENSE
ID
Enumeration date
08/25/2009
Last updated
08/25/2009
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