| NPI | 1538657960 |
|---|---|
| Former Name | KELSEY LYNN BERGGREN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002523A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2024-02-12 |