Individual
KATE C BERGLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5050 NE HOYT ST, SUITE 511, PORTLAND, OR 97213-2991
(503) 962-1020
(503) 962-1021
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA156507
OR
363AS0400X
Surgical Physician Assistant
PA156507
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821315912
—
WA
05
—
500639509
—
OR
01
—
P01238740
RR MEDICARE - PROVIDENCE
OR
Enumeration date
04/28/2010
Last updated
02/05/2021
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