Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN.CNP.0028676 | OH |
NPI | 1023699030 |
---|---|
Provider Name | Jillian Bergey |
First Address | Avon Lake, OH 44012-2589 |
Second Address | Warren, OH 44484-4503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 20/04/2021 |