Individual
TRACY L BERGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-C, APNP
Contact information
Practice address
N6781 WOODFIELD LN, LAKE MILLS, WI 53551-9735
(920) 222-0354
Mailing address
N6781 WOODFIELD LN, LAKE MILLS, WI 53551-9735
(920) 222-0354
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
98981-30
WI
363L00000X
Nurse Practitioner
Primary
9748-33
WI
363LF0000X
Family Nurse Practitioner
F08191041
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750929972
—
WI
Enumeration date
12/18/2019
Last updated
01/09/2026
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