Provider Demographics
NPI:1194075853
Name:BERGREN, REBECCA JOY (ARNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:BERGREN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JOY
Other - Last Name:SCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1459 S HIGLEY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-5047
Mailing Address - Country:US
Mailing Address - Phone:480-556-0446
Mailing Address - Fax:
Practice Address - Street 1:1459 S HIGLEY RD STE 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-5047
Practice Address - Country:US
Practice Address - Phone:480-556-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00150427163W00000X
WAAP60311595363LF0000X
AZ313125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022540Medicaid