Healthcare Provider Details

I. General information

NPI: 1548774615
Provider Name (Legal Business Name): TWYLA DAWN BERGENSTAL DNP, AGACNPBC, FNPBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

3115 WILD FLOWER TRL
MEDINA MN
55340-8805
US

V. Phone/Fax

Practice location:
  • Phone: 612-876-6644
  • Fax:
Mailing address:
  • Phone: 612-876-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5572
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5572
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2125792
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: