Healthcare Provider Details

I. General information

NPI: 1447189568
Provider Name (Legal Business Name): SHARON K MATUSZKIEWICZ BERGEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE 4460
SOUTH BEND IN
46601-1168
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-235-1010
  • Fax: 574-232-2064
Mailing address:
  • Phone: 574-647-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28198772A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: