Provider Demographics
NPI:1568086205
Name:SCHATTSCHNEIDER, BERGEN NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:BERGEN
Middle Name:NICOLE
Last Name:SCHATTSCHNEIDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BERGEN
Other - Middle Name:NICOLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4108 73RD ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2644
Mailing Address - Country:US
Mailing Address - Phone:515-434-3151
Mailing Address - Fax:
Practice Address - Street 1:2530 CHAMBERLAIN ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7272
Practice Address - Country:US
Practice Address - Phone:877-811-7526
Practice Address - Fax:515-292-5340
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant