Breanna K Bergeron, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI60595970 Issued in WA

Practice address

212 E Central Ave
Ste. 440
Spokane, WA 99208-6291

Phone

(509) 252-9602

Fax

(509) 227-7070

NPI assigned

Mar 13, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1013040849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190421",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 E CENTRAL AVE",
            "address_2": "STE. 440",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992086291",
            "telephone_number": "509-252-9602",
            "fax_number": "509-227-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "BREANNA",
        "middle_name": "K",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AK",
            "license": "175",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-530",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60595970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DT9813",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne-Marie C Bergeleen, ARNP
• Sarah Bergen, PMHNP-BD
• Matthew Berger, M.D.
• Nicholas Gerard Berger, M.D.
• Sylvia Berger, MA, LPC, LAC, LCMHA
• Rebekah Isabel Bergeron, RN
• Danielle N Bergeson
• Erik Bergeson, PA
• Erin Drew Bergey, CRNA
• Joyce Patricia Barbara Bergfield, CPC

• Registered Dietitian in Spokane, WA
• Providers in Spokane, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.