| NPI | 1114300514 |
|---|---|
| Former Name | DANA BERGSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7310) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05774) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2020-06-19 |