Provider Demographics
NPI:1811715980
Name:BERGREN, STEPHANIE (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BERGREN
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 S MICHIGAN AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1253
Mailing Address - Country:US
Mailing Address - Phone:847-346-5252
Mailing Address - Fax:
Practice Address - Street 1:215 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1533
Practice Address - Country:US
Practice Address - Phone:847-346-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily