1568086205 NPI number — BERGEN NICOLE SCHATTSCHNEIDER PA

Table of content: BERGEN NICOLE SCHATTSCHNEIDER PA (NPI 1568086205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568086205 NPI number — BERGEN NICOLE SCHATTSCHNEIDER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHATTSCHNEIDER
Provider First Name:
BERGEN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
BERGEN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568086205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4108 73RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANDALE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50322-2644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-434-3151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 CHAMBERLAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50014-7272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-811-7526
Provider Business Practice Location Address Fax Number:
515-292-5340
Provider Enumeration Date:
05/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  105195 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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