Provider Demographics
NPI:1003880832
Name:BERGERSON, NICOLE J (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:BERGERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 W CENTER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1900
Mailing Address - Country:US
Mailing Address - Phone:402-505-9550
Mailing Address - Fax:402-614-3414
Practice Address - Street 1:9239 W CENTER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1900
Practice Address - Country:US
Practice Address - Phone:402-505-9550
Practice Address - Fax:402-614-3414
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE213182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025118600Medicaid
NE10025118600Medicaid
099556Medicare ID - Type Unspecified