Individual
NICOLE MARIE BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
702 COMMERCE DR, SUITE 100, PERRYSBURG, OH 43551-5239
(419) 872-4673
(419) 873-8329
Mailing address
815 COMMERCE DR, SUITE 100, PERRYSBURG, OH 43551-5255
(419) 872-4673
(419) 873-8329
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.003246
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9344881
MEDICARE GROUP
OH
01
—
DD1846
RAILROAD MEDICARE GROUP
OH
Enumeration date
04/05/2011
Last updated
11/07/2016
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