Provider Demographics
NPI:1205113156
Name:BERGBAUER, MARION WANJIRU (CRNA)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:WANJIRU
Last Name:BERGBAUER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARION
Other - Middle Name:WANJIRU
Other - Last Name:NJOROGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1075 KINGWOOD DR STE 150
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3003
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713315367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294729301Medicaid
TX8685UCOtherBCBS
TX294729301Medicaid