Provider Demographics
NPI:1902274152
Name:BERGLUND, LAURIE W
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:W
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:SUE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8200 DODGE ST
Mailing Address - Street 2:CHILDREN'S HOSPITAL & MEDICAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:
Practice Address - Street 1:110 N 175TH ST STE 1000
Practice Address - Street 2:CHILDREN'S HOSPITAL & MEDICAL CENTER URGENT CARE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3581
Practice Address - Country:US
Practice Address - Phone:402-955-8300
Practice Address - Fax:402-955-7310
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111870363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner