Provider Demographics
NPI:1508600404
Name:BERGQUIST, DENALI
Entity type:Individual
Prefix:
First Name:DENALI
Middle Name:
Last Name:BERGQUIST
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 1:2075 COOPER ST APT 734
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-2034
Mailing Address - Country:US
Mailing Address - Phone:307-351-2159
Mailing Address - Fax:
Practice Address - Street 1:2075 COOPER ST APT 734
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-2034
Practice Address - Country:US
Practice Address - Phone:307-351-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer