BRENDA BERGHOLM (NPI# 1548493521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548493521 |
| Entity Type | Individual |
| Full Name | BRENDA BERGHOLM |
| Credential | MSN, ACNS-BC |
| Practice Address |
300 S 3rd W Soda Springs ID 83276-1559 |
| Practice Telephone | 2085473341 |
| Practice Fax Number | 2085472790 |
| Mailing Telephone | 2085473341 |
| Mailing Fax Number | 2085472790 |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2009-08-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SA2200X |
Clinical Nurse Specialist Specialization: Adult Health |
CNS-47A | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | IDAHO STATE LICENSE | CNS-47A | 01 |
| Street Address |
300 S 3RD W |
| City | SODA SPRINGS |
| State | ID |
| Zip Code | 83276-1559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912998261 | Caribou Memorial Hospital | General Acute Care Hospital | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2005-11-03 |
| 1619509783 | David C Telford | Physical Therapist | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2020-02-06 |
| 1790244721 | Kevin Courtney Smith | Physical Medicine & Rehabilitation | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2019-03-19 |
| 1467901876 | Aaron Christopher Hobbs | Nurse Practitioner | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2016-09-26 |
| 1184097271 | Ronald Rutten | Physical Therapist | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2015-11-11 |
| 1285970582 | Caribou Memorial Hospital | Clinic/Center | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2012-12-14 |
| 1861770414 | Rmc Management, LLC | Surgery | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2011-08-01 |
| 1407000466 | Joshua Reed Torman | Nurse Anesthetist, Certified Registered | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2008-11-04 |
| 1235380072 | Edward Rodney Vangass | Social Worker | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2008-10-09 |
| 1154524403 | Caribou Memorial Hospital | Clinic/Center | 300 S 3rd W, Soda Springs, ID 83276-1559 | 2007-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811390248 | Terry Lee Christensen | Physical Therapy Assistant | 279 E. 3rd N., Soda Springs, ID 83276 | 2014-09-30 |
| 1285049387 | Matthew F Kunz | Dentist | 180 S. Main Street, Soda Springs, ID 83276 | 2014-06-26 |
| 1801086012 | Caribou Memorial Hospital | Specialist | 300 South 3rd West, Soda Springs, ID 83276 | 2007-07-25 |
| 1386681427 | Eron J Evans | Dentist | 390 S 3rd W, Mountain View Dental, Soda Springs, ID 83276 | 2006-05-31 |
| 1154310373 | Jerry H Walker | Dentist | 390 South 3rd West, Soda Springs, ID 83276 | 2005-10-20 |
| 1184022105 | Inner Light Counseling, LLC | Social Worker | 61 E 1st S, Soda Springs, ID 83276 | 2014-12-08 |
| 1710158886 | Mountain View Dental Clinic | Clinic/Center | 390 South 3rd West, Soda Springs, ID 83276 | 2008-03-17 |
| 1730240375 | Sharman Kay Snow | Social Worker | 160 N 1st E, Soda Springs, ID 83276-1203 | 2006-12-13 |
| 1609245612 | Craig Harden Richardson | Specialist/Technologist | 366 N 2nd E, Soda Springs, ID 83276-1218 | 2015-09-20 |
| 1417370388 | Saxton Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 269 N 3rd E, Soda Springs, ID 83276-1226 | 2014-01-29 |
| Find all providers in zip 83276 | ||||
| Taxonomy Code | 364SA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548549249 | College of Western Idaho-medical Express Care Clinic | Clinical Nurse Specialist | 2407 Nampa Caldwell Blvd, No. 168, Nampa, ID 83651-1515 | 2011-08-11 |
| 1043512692 | Abigail Louise Bell | Clinical Nurse Specialist | 801 Pole Line Rd W Ste 3810, Twin Falls, ID 83301-5811 | 2010-12-01 |
| 1720230766 | Kathy D Archibald | Clinical Nurse Specialist | 2302 E Terry St, Pocatello, ID 83201-2733 | 2008-10-22 |
| 1467064568 | Rick D Bassett | Clinical Nurse Specialist | 720 E Park Blvd, Boise, ID 83712-7758 | 2020-08-19 |
| 1306274006 | Jocelyn L Mccullough | Clinical Nurse Specialist | 6140 W Curtisian, Ste 200, Boise, ID 83704 | 2013-10-16 |
| 1447598016 | Christine Clair Shirazi | Clinical Nurse Specialist | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2013-01-16 |
| 1962709550 | Jane Kelsey Spencer | Clinical Nurse Specialist | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2011-02-17 |
| 1275836157 | Debra Lynn Rodriguez | Clinical Nurse Specialist | 777 Hospital Way, Pocatello, ID 83201-5162 | 2010-12-14 |
| 1902039951 | Cynthia Love Barron | Clinical Nurse Specialist | 777 Hospital Way Bldg A, 101, Pocatello, ID 83201-2753 | 2009-08-25 |
| 1659540292 | Pocatello Cardiology Associates | Clinical Nurse Specialist | 777 Hospital Way Bldg A, Ste. 101, Pocatello, ID 83201-2753 | 2008-02-28 |
| Find all providers with the same taxonomy | ||||
| City | SODA SPRINGS |
| Zip Code | 83276 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.