Individual
MRS. SAMANTHA BERGESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9200 W WISCONSIN AVE, ELECTROPHYSIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6000
(414) 805-6280
Mailing address
9200 W WISCONSIN AVE, ELECTROPHYSIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6000
(414) 805-6280
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
190167-30
WI
363L00000X
Nurse Practitioner
937733
WI
363LA2200X
Adult Health Nurse Practitioner
Primary
937733
WI
363LG0600X
Gerontology Nurse Practitioner
937733
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588216345
—
WI
Enumeration date
07/11/2019
Last updated
11/07/2023
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