| NPI | 1326227752 |
|---|---|
| Former Name | LESLEE LYNN BERGUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-26476) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01066304A) |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2021-07-30 |