Individual
DANE BERGESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA, BSN
Contact information
Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 983-3361
Mailing address
994 S MILITARY DR, SALT LAKE CITY, UT 84108-1326
(801) 645-4205
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
122443
FL
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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