Provider Demographics
NPI:1487102299
Name:BERGREN, LAUREL (APN)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:BERGREN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S NAPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5423
Mailing Address - Country:US
Mailing Address - Phone:630-221-0200
Mailing Address - Fax:630-384-2644
Practice Address - Street 1:7008 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2151
Practice Address - Country:US
Practice Address - Phone:708-795-7040
Practice Address - Fax:708-795-5664
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily