Basic Information
| Provider Information | |||||||||
| NPI: | 1396197489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGERON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4077 WEST RD | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077539977 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32 GRAHAM AVE | ||||||||
| Address2: | B-26 VAN HOESEN HALL | ||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077534811 | ||||||||
| FaxNumber: | 6077532486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2016 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F340768-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.