NPI 1356417513 · live from the CMS NPI Registry
Tracy Bergeron, RD, LDN
Dietitian, Registered, Nutrition, Pediatric in Providence, RI. National Provider Identifier 1356417513, active.
NPI record
| NPI | 1356417513 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered, Nutrition, Pediatric 133VN1004X |
| Practice location | 593 Eddy St, Providence, RI 02903 |
| Practice phone | 401-444-6966 |
| Mailing address | 167 Point St, Providence, RI 02903 |
| Enumerated | November 28, 2006 |
| Last updated | July 9, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered, Nutrition, Pediatric primary | 133VN1004X | LDN00554 (RI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.