Provider Demographics
NPI:1598810574
Name:BERGERON, NICOLE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNE
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:BERGERON
Other - Last Name:KARCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2021 PERDIDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1352
Mailing Address - Country:US
Mailing Address - Phone:504-903-3594
Mailing Address - Fax:
Practice Address - Street 1:122 SHERWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3717
Practice Address - Country:US
Practice Address - Phone:504-486-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023563207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine