MS. MALLORIE A BERGSTROM (NPI# 1730490012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730490012 |
| Entity Type | Individual |
| Full Name | MS. MALLORIE A BERGSTROM |
| Credential | PA-C |
| Practice Address |
3201 S 16th St Milwaukee WI 53215-4537 |
| Mailing Address |
833 N 21st St Apt 108 Milwaukee WI 53233-1686 |
| Practice Telephone | 4146475203 |
| Mailing Telephone | 4148036877 |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2010-07-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2591-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3201 S 16TH ST |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53215-4537 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962400234 | Emmanuel Sison Manuel | Urology | 3201 S 16th St, Ste 1015, Milwaukee, WI 53215-4537 | 2005-07-12 |
| 1386027787 | Sarah Kelly | Physician Assistant | 3201 S 16th St, Suite 100, Milwaukee, WI 53215-4537 | 2015-07-02 |
| 1639563315 | Jessica Mahsem | Nurse Practitioner | 3201 S 16th St, Suite 2015, Milwaukee, WI 53215-4537 | 2015-03-20 |
| 1619302973 | Kieley Paidisetty | Nurse Practitioner | 3201 S 16th St, #1000, Milwaukee, WI 53215-4537 | 2013-09-05 |
| 1629380993 | Kari Best | Physician Assistant | 3201 S 16th St, Suite 100, Milwaukee, WI 53215-4537 | 2010-07-02 |
| 1164651311 | Allison Margaret Juech | Physician Assistant | 3201 S 16th St, Suite 100, Milwaukee, WI 53215-4537 | 2009-07-09 |
| 1629219936 | Jose Antony Pulikkal Paul | Internal Medicine | 3201 S 16th St, Suite 2015, Milwaukee, WI 53215-4537 | 2009-03-16 |
| 1922247790 | Nishant Pillai | Emergency Medicine | 3201 S 16th St, Suite 100, Milwaukee, WI 53215-4537 | 2009-02-18 |
| 1578725180 | Beth Ann Griffin | Emergency Medicine | 3201 S 16th St, Milwaukee, WI 53215-4537 | 2008-06-26 |
| 1750541611 | Maqbool Arshad,m.d. | Durable Medical Equipment & Medical Supplies | 3201 S 16th St, #2020, Milwaukee, WI 53215-4537 | 2008-06-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841829918 | Joshua Michael Brooks | Student in an Organized Health Care Education/Training Program | Aurora St. Lukes Medical Center 2901 W Oklahoma Ave, Milwaukee, WI 53215 | 2020-04-02 |
| 1053967091 | Kristina Strupp | Clinical Nurse Specialist | 2900 W. Oaklahoma Avenue, Milwaukee, WI 53215 | 2019-08-15 |
| 1427510296 | Madelyn Pickle | Student in an Organized Health Care Education/Training Program | 2801 W. Kinnickinnic Rd Ste 250, Milwaukee, WI 53215 | 2019-04-02 |
| 1932601838 | Elizabeth D Morawski | Nurse Practitioner | 2801 Kinnickinnic Parkway, Suite 630, Milwaukee, WI 53215 | 2018-03-06 |
| 1457872673 | Canzata Kimberly Dent | Counselor | 2727 W. Cleveland Suite 204, Milwaukee, WI 53215 | 2017-06-28 |
| 1538689955 | Christian Pena | Durable Medical Equipment & Medical Supplies | 2800 W Forest Home Ave, Suite 100, Milwaukee, WI 53215 | 2017-06-27 |
| 1386178804 | Dane A Olsen | Family Medicine | 801 W Kinnickinnic River Pkwy., Suite 250, Milwaukee, WI 53215 | 2017-04-12 |
| 1811443492 | Thomas Diamond | Physical Therapist | 2901 Kinnickinnic Parkway, Milwaukee, WI 53215 | 2016-09-01 |
| 1487055133 | Sam Khalili | Otolaryngology | 2801 W Kinnickinnic River Pkwy # 680, Milwaukee, WI 53215 | 2014-09-12 |
| 1992105621 | Nicole R Hall | Nurse Practitioner | 2901 S Kinnickinnic Ave, Milwaukee, WI 53215 | 2014-08-29 |
| Find all providers in zip 53215 | ||||
| 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 |
|---|---|---|---|---|
| 1386257194 | Harrison R Pham | Physician Assistant | 214 E Florida St Apt 526, Milwaukee, WI 53204-1657 | 2020-08-31 |
| 1942824602 | Rebecca Frances Hasler | Physician Assistant | 2368 N Humboldt Blvd, Milwaukee, WI 53212-3524 | 2020-05-28 |
| 1194355784 | Ashley Bishop Henning | Physician Assistant | 2350 N Lake Dr Ste 404, Milwaukee, WI 53211-4528 | 2020-01-22 |
| 1902457575 | Kathryn Kasper | Physician Assistant | 2408 N Buffum St, Milwaukee, WI 53212-2902 | 2019-09-25 |
| 1972151314 | Kelly J Meyer | Physician Assistant | 2900 W Oklahoma Ave Ste 414, Milwaukee, WI 53215-4330 | 2019-08-28 |
| 1659923795 | Mikayla Preissner | Physician Assistant | 788 N Jefferson St Ste 401, Milwaukee, WI 53202-3718 | 2019-07-09 |
| 1245892124 | Emily Mason | Physician Assistant | 2901 W Kk River Pkwy Ste 507, Milwaukee, WI 53215-3660 | 2019-07-01 |
| 1124513528 | Kirby Kristine Hancock | Physician Assistant | 2350 N Lake Dr Ste 302, Milwaukee, WI 53211-4528 | 2018-06-27 |
| 1548785785 | Anne Gustavson | Physician Assistant | 5500 W Brown Deer Rd Ste 400, Milwaukee, WI 53223-2265 | 2017-08-09 |
| 1205359973 | Christina Marie Rende | Physician Assistant | 2350 N Lake Dr Ste 206, Milwaukee, WI 53211-4528 | 2017-07-24 |
| Find all providers in MILWAUKEE | ||||
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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.