NPI 1437395944

Jennifer Ruth Bergquam, LMP

Practitioner Specialist Lake Stevens, WA

Practice location

Address: 9623 32nd St SE, Lake Stevens, WA 98258
Phone: (360) 834-6964
Mailing address: 8242 42nd St NE, Marysville, WA 98270

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 60055734 (WA)

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Registry record

NPI: 1437395944
Entity type: Individual
Sex (as registered): Female
NPI issued: 5 Jan 2009
Record last updated: 19 Sep 2014

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.