Individual
NINA L BERGQUAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1003 PROVIDENCE DR, STE 110, NEWBERG, OR 97132-7521
(503) 537-5900
(503) 537-5959
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD21625
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00250292
RR MEDICARE
OR
Enumeration date
06/08/2006
Last updated
02/05/2021
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