Provider Demographics
NPI:1740826684
Name:BERGMAN, JESSICA SUE (APRN-CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1657
Mailing Address - Country:US
Mailing Address - Phone:567-890-7185
Mailing Address - Fax:
Practice Address - Street 1:950 S MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2474
Practice Address - Country:US
Practice Address - Phone:419-586-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.0194909367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife