Individual
JENNIFER RUTH BERGQUAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
9623 32ND ST SE, LAKE STEVENS, WA 98258
(360) 834-6964
Mailing address
8242 42ND ST NE, MARYSVILLE, WA 98270
(360) 921-3358
(425) 320-4091
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
60055734
WA
Other
Enumeration date
01/05/2009
Last updated
09/19/2014
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