Healthcare Provider Details

I. General information

NPI: 1720338114
Provider Name (Legal Business Name): ASHLIE BERGREN RN BSN IBCLC RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 N 1ST STREET
SPRINGFIELD NE
68059
US

IV. Provider business mailing address

780 N 1ST STREET
SPRINGFIELD NE
68059
US

V. Phone/Fax

Practice location:
  • Phone: 402-658-0578
  • Fax:
Mailing address:
  • Phone: 402-658-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number66714
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11075800
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: