Provider Demographics
NPI:1184919615
Name:BERGEN, HEIDI ANN (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:BERGEN
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:EDGAR
Mailing Address - State:NE
Mailing Address - Zip Code:68935-0406
Mailing Address - Country:US
Mailing Address - Phone:402-224-3344
Mailing Address - Fax:402-224-3099
Practice Address - Street 1:315 N C ST
Practice Address - Street 2:
Practice Address - City:EDGAR
Practice Address - State:NE
Practice Address - Zip Code:68935-3194
Practice Address - Country:US
Practice Address - Phone:402-224-3344
Practice Address - Fax:402-224-3099
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE111253OtherSTATE OF NEBRASKA-APRN
NE55203OtherSTATE OF NEBRASKA-RN