Provider Demographics
NPI:1356810949
Name:BERGREN, MADISON SARA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:SARA
Last Name:BERGREN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:MADISON
Other - Middle Name:SARA
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:700 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:IA
Mailing Address - Zip Code:50841-1419
Mailing Address - Country:US
Mailing Address - Phone:641-322-4431
Mailing Address - Fax:641-322-5052
Practice Address - Street 1:1700 W TOWNLINE ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1054
Practice Address - Country:US
Practice Address - Phone:712-318-9152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152197163W00000X
IAF11220122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse