Individual
ELISA BERGQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 LEGACY PLZ W, LA PORTE, IN 46350-5254
(219) 326-0943
(219) 326-5684
Mailing address
401 NEWPORTE BLVD, LA PORTE, IN 46350-2479
(219) 575-6244
(219) 380-0757
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005757A
IN
Other
Enumeration date
09/09/2015
Last updated
09/18/2020
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