Individual
MARDELLE ANN BERGSTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12405 S 218TH ST, GRETNA, NE 68028-5987
(402) 932-2284
Mailing address
12405 SO 218TH STREET, GRETNA, NE 68028
(402) 932-2284
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5217
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5217
LPN LICESENE NUMBER
NE
Enumeration date
12/01/2010
Last updated
12/01/2010
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