Healthcare Provider Details

I. General information

NPI: 1902166481
Provider Name (Legal Business Name): MICHELE JEAN BERGMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE JEAN ROBINSON RN

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 NW 22ND AVE STE 500
PORTLAND OR
97210-3057
US

IV. Provider business mailing address

1014 N SPRINGBROOK RD STE B
NEWBERG OR
97132-2061
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-5050
  • Fax:
Mailing address:
  • Phone: 503-449-8988
  • Fax: 503-894-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201501470NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201501470NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201501470NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number201501470NP-PP
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number201501470NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: