Provider Demographics
NPI:1144732017
Name:BERGEN, MICHELLE ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:BERGEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E SPRUCE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3372
Mailing Address - Country:US
Mailing Address - Phone:559-439-5757
Mailing Address - Fax:559-437-3943
Practice Address - Street 1:1275 E SPRUCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3372
Practice Address - Country:US
Practice Address - Phone:559-439-5757
Practice Address - Fax:559-437-3943
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007057363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care