Provider Demographics
NPI:1871639021
Name:BERGESEN, LORETTA M (FNP,RNCS)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:M
Last Name:BERGESEN
Suffix:
Gender:F
Credentials:FNP,RNCS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5 FEDERAL STREET
Mailing Address - Street 2:LAHEY HEALTH PRIMARY CARE, DANVERS
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-750-0200
Mailing Address - Fax:978-450-0220
Practice Address - Street 1:5 FEDERAL STREET
Practice Address - Street 2:LAHEY HEALTH PRIMARY CARE, DANVERS
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3629
Practice Address - Country:US
Practice Address - Phone:978-750-0200
Practice Address - Fax:978-450-0220
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA130700363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily