Provider Demographics
NPI:1659093854
Name:BERGESON, CARL ERIK (APRN)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ERIK
Last Name:BERGESON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-1632
Mailing Address - Country:US
Mailing Address - Phone:401-623-1922
Mailing Address - Fax:
Practice Address - Street 1:117 ELLENFIELD ST STE 101
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4541
Practice Address - Country:US
Practice Address - Phone:401-846-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03208363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care