NPI 1003228925

Tabetha Emily Bergeron, PAC

Practitioner Physician Assistant Grand Rapids, MI

Practice location

Address: 4069 Lake Dr SE, Grand Rapids, MI 49546-8816
Phone: (616) 267-7469
Mailing address: 100 Michigan St NE Mc 845, Grand Rapids, MI 49503-2560

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 5601006952 (MI)

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Registry record

NPI: 1003228925
Entity type: Individual
Sex (as registered): Female
NPI issued: 27 May 2014
Record last updated: 12 Jun 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.