Provider Demographics
NPI:1265092076
Name:BERGLIND, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BERGLIND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 NW MOUNT VINTAGE WAY STE 221
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6039
Mailing Address - Country:US
Mailing Address - Phone:360-792-9118
Mailing Address - Fax:360-918-9726
Practice Address - Street 1:3261 NW MOUNT VINTAGE WAY STE 221
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6039
Practice Address - Country:US
Practice Address - Phone:360-792-9118
Practice Address - Fax:360-918-9726
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60971045363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care