MEDICARE: MRS. ANN MARIE BERGREN MSN FNP

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	363LF0000X	Family Nurse Practitioner	267800	AZ
2	363LF0000X	Family Nurse Practitioner	5444	WI

General Provider Information

NPI Number	:	1518392752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN MARIE BERGREN MSN FNP

Provider Business Mailing Address
First Line	:	2929 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8034
Country	:	US
Telephone Number	:	602-470-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1808
Country	:	US
Telephone Number	:	480-344-6550
Fax Number	:

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

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	06/20/2022

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