Individual
DAWN ELIZABETH BERGERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FMCHC AND IHP2
Contact information
Practice address
2901 LONE OAK RD, BLOOMINGTON, IL 61705-7802
(309) 846-0899
Mailing address
2901 LONE OAK RD, BLOOMINGTON, IL 61705-7802
(309) 846-0899
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
171400000X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171400000X
GENERAL
—
Enumeration date
03/03/2023
Last updated
03/03/2023
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