MEDICARE: STEPHANIE BERGERON

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	363L00000X	Nurse Practitioner	16616	CT

General Provider Information

NPI Number	:	1740135920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BERGERON

Provider Business Mailing Address
First Line	:	1854 CHAMBERLAIN HWY
Second Line	:
City	:	BERLIN
State	:	CT
Zip	:	06037-3903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 CHAMBERLAIN HWY
Second Line	:
City	:	BERLIN
State	:	CT
Zip	:	06037-3903
Country	:	US
Telephone Number	:	978-204-4918
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ STEPHANIE BERGERON ” Practice Location

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