Provider Demographics
NPI:1306861836
Name:BERGMAN, BARBARA A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5668 STATE HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-9709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N2665 HIGHWAY QQ
Practice Address - Street 2:WISCONSIN VETERANS HOME PHARMACY
Practice Address - City:KING
Practice Address - State:WI
Practice Address - Zip Code:54946
Practice Address - Country:US
Practice Address - Phone:715-258-1674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17019-031164W00000X
183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered183700000XPharmacy Service ProvidersPharmacy Technician