MEDICARE: JENNIFER GORMAN BERGEN FNP-BC, 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	363LF0000X	Family Nurse Practitioner	209029984	IL

General Provider Information

NPI Number	:	1710725767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GORMAN BERGEN FNP-BC, APRN

Provider Business Mailing Address
First Line	:	2400 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0851
Country	:	US
Telephone Number	:	708-921-5430
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0851
Country	:	US
Telephone Number	:	773-270-5600
Fax Number	:

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

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	03/02/2026

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