MR. DEANE BERGSRUD (NPI# 1124234455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124234455 |
| Entity Type | Individual |
| Full Name | MR. DEANE BERGSRUD |
| Credential | P.A. |
| Practice Address |
4660 Kenmore Ave Suite 900 Alexandria VA 22304-1313 |
| Practice Telephone | 7032120700 |
| Practice Fax Number | 7032120705 |
| Mailing Telephone | 7032120700 |
| Mailing Fax Number | 7032120705 |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0110000120 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4660 KENMORE AVE SUITE 900 |
| City | ALEXANDRIA |
| State | VA |
| Zip Code | 22304-1313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841292091 | Lawrence R. Rubin | Internal Medicine | 4660 Kenmore Ave, Ste 1200, Alexandria, VA 22304-1311 | 2005-06-01 |
| 1316403645 | Felicia Cooper | Nurse Practitioner | 4660 Kenmore Ave, Alexandria, VA 22304-1313 | 2019-02-12 |
| 1659812832 | Northern Virginia Laboratory | Clinical Medical Laboratory | 4660 Kenmore Ave, Alexandria, VA 22304-1313 | 2017-03-20 |
| 1023472388 | Dakota Ferrell | Occupational Therapist | 4660 Kenmore Ave, Ste 400, Alexandria, VA 22304-1313 | 2016-04-12 |
| 1194198952 | Stephanie Anne Shaffer | Advanced Practice Midwife | 4660 Kenmore Ave, Suite 902, Alexandria, VA 22304-1313 | 2015-11-02 |
| 1396113270 | Cecelia Brown | Advanced Practice Midwife | 4660 Kenmore Ave, Suite 902, Alexandria, VA 22304-1313 | 2015-09-09 |
| 1437535358 | Kathleen Martin Bell | Nurse Practitioner | 4660 Kenmore Ave, Suite 902, Alexandria, VA 22304-1313 | 2015-08-03 |
| 1760866842 | Kimberly Ann Miller | Nurse Practitioner | 4660 Kenmore Ave, Suite 600, Alexandria, VA 22304-1313 | 2015-07-17 |
| 1649654716 | Nicole Lobo | Physical Therapy Assistant | 4660 Kenmore Ave, Suite 400, Alexandria, VA 22304-1313 | 2015-07-17 |
| 1336522986 | Elise Faith | Midwife | 4660 Kenmore Ave, Suite 902, Alexandria, VA 22304-1313 | 2015-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407489768 | Anthony Michael Frato | Counselor | 205 S Whiting St #601, Alexandria, VA 22304 | 2020-02-14 |
| 1245885805 | Personal Touch Personal Care Providers, LLC | In Home Supportive Care | 4241-d8 Duke Street, Alexandria, VA 22304 | 2019-08-09 |
| 1336658772 | Jade F. Hillery | Doula | 5240 Duke St #310, Alexandria, VA 22304 | 2017-09-28 |
| 1447784731 | Aymara Matos | Behavioral Analyst | 5426 Richenbacher Ave Apt 100, Alexandria, VA 22304 | 2017-04-13 |
| 1659827871 | Tesfaye A Hailemariam Dds PC | Dentist | 5764 Dow Ave, Alexandria, VA 22304 | 2016-08-28 |
| 1912302605 | Alexandria Health Department | Clinic/Center | 1200 North Howard, Alexandria, VA 22304 | 2014-10-24 |
| 1497157663 | Aminata Jalloh | Registered Nurse | 101 South Whiting St, Alexandria, VA 22304 | 2014-09-19 |
| 1386075133 | Carla Renee Riley | Registered Nurse | 4320 Raleigh Ave, Apt 204, Alexandria, VA 22304 | 2013-12-04 |
| 1700223500 | Landmark Dental Care | Dentist | 101 S. Whiting St., Suite 100, Alexandria, VA 22304 | 2013-06-03 |
| 1114266954 | Stella M Meusch | Physician Assistant | 4230 Seminary Rd, Alexandria, VA 22304 | 2013-02-13 |
| Find all providers in zip 22304 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962015750 | Hannah Wallen | Physician Assistant | 8101 Hinson Farm Rd Ste 501, Alexandria, VA 22306-3403 | 2020-08-31 |
| 1811509953 | Trenton Todd Thelen | Physician Assistant | 2000 Huntington Ave Apt 1201, Alexandria, VA 22303-1715 | 2020-08-19 |
| 1497310056 | Melissa Marie Spooner | Physician Assistant | 277 S Washington St Ste 100, Alexandria, VA 22314-3678 | 2019-05-08 |
| 1568025880 | Rola Mourad | Physician Assistant | 7508 Snowpea Ct Unit F, Alexandria, VA 22306-2258 | 2019-04-22 |
| 1114491248 | Skylar Alexa Lisse | Physician Assistant | 426 S Columbus St, Alexandria, VA 22314-3606 | 2019-01-11 |
| 1891151494 | Michelle Malzahn Shelton | Physician Assistant | Red River Cardiology, 201 4th Street, Ste. 4a, Alexandria, LA 71301-8421 | 2016-01-12 |
| 1285004051 | Virginia Minehart Cinzano | Physician Assistant | 6355 Walker Ln Ste 401, Alexandria, VA 22310-3250 | 2015-10-05 |
| 1457791956 | Elise Marie Nash Ferre | Physician Assistant | 6161 Edsall Rd, Apt 203, Alexandria, VA 22304-4166 | 2013-06-28 |
| 1114266954 | Stella M Meusch | Physician Assistant | 4230 Seminary Rd, Alexandria, VA 22304 | 2013-02-13 |
| 1396080800 | Laura Provenzano | Physician Assistant | 3117 Duke St, Alexandria, VA 22314-4518 | 2012-12-10 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 22304 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.