Provider Demographics
NPI:1902166481
Name:BERGMANN, MICHELE JEAN (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:JEAN
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:JEAN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1014 N SPRINGBROOK RD
Mailing Address - Street 2:STE B
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2061
Mailing Address - Country:US
Mailing Address - Phone:503-449-8988
Mailing Address - Fax:503-894-9194
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:STE 500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-227-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201501470NP-PP363L00000X, 363LA2200X, 363LF0000X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology