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1730490012
MALLORIE A BERGSTROM
WAUWATOSA, WI
NPI
1730490012
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: WI 2591-23)
Enumeration Date
2010-07-01
Last Update Date
2022-05-02
Business Address
Ms. MALLORIE A BERGSTROM PA-C
2727 N MAYFAIR RD STE I
WAUWATOSA, WI 53222-4400
Phone number: 414-727-0910
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Mailing Address
Ms. MALLORIE A BERGSTROM PA-C
PO BOX 26071
WAUWATOSA, WI 53226-0071
Phone number: 414-727-0910
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