Nicole Bergevain

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

239635 Issued in WI

Practice address

5735 Durand Ave
Mount Pleasant, WI 53406-5011

Phone

(262) 598-1392

NPI assigned

Jul 30, 2024

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Quality Addiction Management Inc

  • Methadone Clinic
  • Kenosha, WI
  • NPI 1184354979
  NPD (past)
• Quality Addiction Management Inc

  • Methadone Clinic
  • Green Bay, WI
  • NPI 1629282470
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 30, 2024.

{
    "created_epoch": "1722297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1184453003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9009 CAROTHERS PKWY STE C1",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370671704",
            "telephone_number": "615-538-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-598-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEVAIN",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "239635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alaina Beatka, OTR/L
• Anne Elizabeth Beeson, MS CCC/SLP
• James Behnke, DPT
• Sarah R Beier-Abdelmawgoud, LAC
• Sarah Belli, PTA
• Eileen Mary Berglund, D.C., LPC
• Alexandra Beris, M.D.
• Jonathan Robert Bernhardt, PHYSICAL THERAPIST
• Beta Diagnostic Labs LLC
• Beta One Health LLC

• All providers in Mount Pleasant, WI
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.