Provider Demographics
NPI:1265839849
Name:BERGNER, AMBER LOUISE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOUISE
Last Name:BERGNER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N30W23861 GREEN RD APT 8
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072
Mailing Address - Country:US
Mailing Address - Phone:414-303-7528
Mailing Address - Fax:
Practice Address - Street 1:W232N7066 SALEM DR
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089
Practice Address - Country:US
Practice Address - Phone:262-246-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195459-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse