Individual
NICOLE BERNDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-1360
Mailing address
W3319 SAND RIDGE RD, PESHTIGO, WI 54157-9592
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6133-33
WI
Other
Enumeration date
11/21/2014
Last updated
11/21/2014
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