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General NPI Number Information
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NPI Number | 1396197489
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Entity Type | Individual
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Provider Name | JESSICA J BERGERON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 32 GRAHAM AVE B-26 VAN HOESEN HALL
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City | CORTLAND
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State | NY
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Zip | 13045-1637
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Country | US
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Telephone | 607-753-4811
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Fax | 607-753-2486
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Provider Business Mailing Address
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Address Line | 4077 WEST RD
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City | CORTLAND
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State | NY
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Zip | 13045-1637
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Country | US
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Telephone | 607-753-9977
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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 | F340768-1
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License Number State | NY
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