MEDICARE: JAMI ERICA BREGENZER PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.024579	OH

General Provider Information

NPI Number	:	1285280479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI ERICA BREGENZER PMHNP

Provider Business Mailing Address
First Line	:	1086 QUEENS RD SE
Second Line	:
City	:	AMSTERDAM
State	:	OH
Zip	:	43903-9706
Country	:	US
Telephone Number	:	330-205-0679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1086 QUEENS RD SE
Second Line	:
City	:	AMSTERDAM
State	:	OH
Zip	:	43903-9706
Country	:	US
Telephone Number	:	330-205-0679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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