Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01082943A | IN |
N | 207V00000X | Obstetrician & Gynecologist | 61650 | WI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 61650 | WI |
NPI | 1003026493 |
---|---|
Provider Name | Danielle M Berdahl |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Fort Wayne, IN 46845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 04/12/2019 |