Provider Demographics
NPI:1912297607
Name:NYBERG, BERNADETTE ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:ANN
Last Name:NYBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:BERNADETTE
Other - Middle Name:ANN
Other - Last Name:TURK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 35100
Mailing Address - Street 2:BILLINGS CLINIC
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-238-5046
Mailing Address - Fax:406-247-6053
Practice Address - Street 1:1020 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0760
Practice Address - Country:US
Practice Address - Phone:406-238-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150031NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646280Medicaid
ORR163655Medicare PIN