Provider Demographics
NPI:1275193542
Name:BERGMAN, MEGHAN DEANNE (NP)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:DEANNE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:DEANNE
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3109
Mailing Address - Country:US
Mailing Address - Phone:704-376-1605
Mailing Address - Fax:704-335-8448
Practice Address - Street 1:1130 N CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1041
Practice Address - Country:US
Practice Address - Phone:336-272-4578
Practice Address - Fax:336-272-5931
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253504363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health