Doctor Name: | JENNIFER RUTH BERGQUAM |
NPI Number: | 1437395944 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | 60055734 |
Business Practice Address: | 9623 32nd St Se Lake Stevens, WA - 98258 |
Business Phone Number: | 3608346964 |
Business Fax Number: | |
Mailing Address: | 8242 42nd St Ne, MARYSVILLE |
State: | WA |
Postal Code: | 98270 |
Phone Number: | 3609213358 |
Fax Number: | 4253204091 |
NPI Enumeration Date: | 01/05/2009 |
NPI Last Update Date: | 09/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 60055734 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |