Healthcare Provider Details

I. General information

NPI: 1376638858
Provider Name (Legal Business Name): MELISSA BERGFELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CASE STREET
NORWICH CT
06360
US

IV. Provider business mailing address

17 CASE STREET
NORWICH CT
06360
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-2461
  • Fax: 860-887-8530
Mailing address:
  • Phone: 860-886-2461
  • Fax: 860-887-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number003126
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number003126
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: