Provider Demographics
NPI:1437204724
Name:BERGERON, MELISSA JO (RN, CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JO
Last Name:BERGERON
Suffix:
Gender:F
Credentials:RN, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SCHOOL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06330-1031
Mailing Address - Country:US
Mailing Address - Phone:860-822-6068
Mailing Address - Fax:860-822-6068
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2740
Practice Address - Country:US
Practice Address - Phone:860-889-8331
Practice Address - Fax:860-823-3865
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE44592163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant