Individual
LAURIE D BERDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2410 W 16TH ST, GREELEY, CO 80634-6004
(970) 352-6353
(970) 356-2264
Mailing address
2410 W 16TH ST, GREELEY, CO 80634-6004
(970) 352-6353
(970) 356-2264
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35412
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01354125
—
CO
01
—
10381125
CAQH
CO
01
—
840592369006
ROCKY MTN HEALTH
CO
01
—
84059236906
PACIFICARE
CO
01
—
BE41887
BCBS
CO
Enumeration date
09/13/2005
Last updated
11/30/2011
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