Provider Demographics
NPI:1164233730
Name:BERGERON, MADELYN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DES ALLEMANDS
Mailing Address - State:LA
Mailing Address - Zip Code:70030-3242
Mailing Address - Country:US
Mailing Address - Phone:504-920-2860
Mailing Address - Fax:
Practice Address - Street 1:304 1ST ST
Practice Address - Street 2:
Practice Address - City:DES ALLEMANDS
Practice Address - State:LA
Practice Address - Zip Code:70030-3242
Practice Address - Country:US
Practice Address - Phone:504-920-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN152646163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant