Basic Information
| Provider Information | |||||||||
| NPI: | 1437204724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGERON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN., CRNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 SCHOOL HILL RD | ||||||||
| Address2: | |||||||||
| City: | BALTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063301031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608226068 | ||||||||
| FaxNumber: | 8608226068 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
| FaxNumber: | 8608233865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | E44592 | CT | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.