Provider Demographics
NPI:1194431197
Name:BERGMAN, JULIE (FNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:ALFARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-9302
Mailing Address - Country:US
Mailing Address - Phone:480-399-7712
Mailing Address - Fax:
Practice Address - Street 1:1711 NEIL DR
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-9302
Practice Address - Country:US
Practice Address - Phone:480-399-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA172604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily