Provider Demographics
NPI:1437480837
Name:BERGLEE, SHARON L (RADIOLOGICAL TECH)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:BERGLEE
Suffix:
Gender:F
Credentials:RADIOLOGICAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1620
Mailing Address - Country:US
Mailing Address - Phone:406-768-3491
Mailing Address - Fax:406-768-3423
Practice Address - Street 1:321 CUSTER ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1620
Practice Address - Country:US
Practice Address - Phone:406-768-3491
Practice Address - Fax:406-768-3423
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2475247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist