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General NPI Number Information
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NPI Number | 1184617128
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Entity Type | Individual
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Provider Name | JUDITH BERGMAN MSN, FNP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 4350 N 19TH AVE SUITE 6
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City | PHOENIX
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State | AZ
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Zip | 85015-4602
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Country | US
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Telephone | 602-264-9191
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Fax | 602-532-2973
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Provider Business Mailing Address
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Address Line | 4041 N CENTRAL AVE BLDG C
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City | PHOENIX
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State | AZ
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Zip | 85012-3313
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Country | US
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Telephone | 602-279-5262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP1139
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN073265
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License Number State | AZ
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