Provider Demographics
NPI:1306245808
Name:BERGMANN, BETSY ANN (CLC)
Entity type:Individual
Prefix:MISS
First Name:BETSY
Middle Name:ANN
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-3026
Mailing Address - Country:US
Mailing Address - Phone:716-628-5262
Mailing Address - Fax:
Practice Address - Street 1:1522 FERRY RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-3026
Practice Address - Country:US
Practice Address - Phone:716-628-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYALPP-42983174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN