Individual provider · NPI-1

Phyllis Bergie-Moore, RD

Dietitian, Registered, Nutrition, Metabolic · Santa Rosa, CA

NPI number1164669792
StatusActive
Last updated in NPPESApr 29, 2010

Details

NPI
1164669792
Entity type
Individual (NPI-1)
Name
Phyllis Bergie-Moore
Credential
RD
Sex
Female
Sole proprietor
No
Enumeration date
Jan 20, 2009
Last updated
Apr 29, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133VN1006X Dietitian, Registered, Nutrition, Metabolic––Yes

Other names

  • Phyllis Vaughn (Former Name)

Practice location

144 Stony Point Rd
Santa Rosa, CA 95401-4122

Phone 707-521-4649 · Fax 707-521-4628

Mailing address

144 Stony Point Rd
Santa Rosa, CA 95401-4122

Phone 707-521-4649 · Fax 707-521-4628

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