Provider Demographics
NPI:1760699896
Name:BERGEY, NANCY JEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:BERGEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2665 COUNTY ROAD QQ
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:WI
Mailing Address - Zip Code:54946-0600
Mailing Address - Country:US
Mailing Address - Phone:715-258-5586
Mailing Address - Fax:715-258-0450
Practice Address - Street 1:N2665 COUNTY ROAD QQ
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:WI
Practice Address - Zip Code:54946-0600
Practice Address - Country:US
Practice Address - Phone:715-258-5586
Practice Address - Fax:715-258-0450
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64407163WP0808X
WIMB2732178364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health