Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH004871L | PA |
NPI | 1063692390 |
---|---|
Provider Name | Linda Jean Bergdahl |
First Address | Erie, PA 16512-0369 |
Second Address | Erie, PA 16503-1808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2007 |
Last Update Date | 03/11/2007 |