Individual
MS. MALLORIE A BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2727 N MAYFAIR RD STE I, WAUWATOSA, WI 53222-4400
(414) 727-0910
(414) 727-0920
Mailing address
PO BOX 26071, WAUWATOSA, WI 53226-0071
(414) 727-0910
(414) 727-0920
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2591-23
WI
Other
Enumeration date
07/01/2010
Last updated
05/02/2022
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