MEDICARE: RACHEL BERGMAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.519916	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0036993	OH

General Provider Information

NPI Number	:	1295589216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL BERGMAN APRN

Provider Business Mailing Address
First Line	:	2495 BRYDEN RD
Second Line	:
City	:	BEXLEY
State	:	OH
Zip	:	43209-2133
Country	:	US
Telephone Number	:	614-370-2518
Fax Number	:

Provider Business Practice Location Address
First Line	:	16888 HARVARD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2208
Country	:	US
Telephone Number	:	216-810-7159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	07/31/2024

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