Provider Demographics
NPI:1295987725
Name:BERGMAN, ABBY (LPN)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2810
Mailing Address - Country:US
Mailing Address - Phone:937-492-8080
Mailing Address - Fax:937-492-6971
Practice Address - Street 1:500 E COURT ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2810
Practice Address - Country:US
Practice Address - Phone:937-492-8080
Practice Address - Fax:937-492-6971
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN128039OtherLICENSE