Provider Demographics
NPI:1891901781
Name:BERGMAN, BETH R (MSN, RN, APN-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:R
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MSN, RN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 TUVIRA LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2671
Mailing Address - Country:US
Mailing Address - Phone:856-489-8456
Mailing Address - Fax:
Practice Address - Street 1:1300 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:NJ
Practice Address - Zip Code:08029-1308
Practice Address - Country:US
Practice Address - Phone:856-939-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00035700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily