Berdahl, Laurie D

Berdahl, Laurie D is an individual health care provider with primary practice located at 2410 W 16Th St , Greeley CO 80634-6004. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Berdahl, Laurie D can be contacted via phone (970) 352-6353.

Contact Information

Primary practice address
2410 W 16Th St Greeley CO 80634-6004
Phone: (970) 352-6353
Fax: (970) 356-2264
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 35412 Colorado

Profile Details

NPI number 1194710392
LBN Legal business name Berdahl, Laurie D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2005
Last updated Nov 30th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194710392 NPPES
Colorado Other 10381125 CAQH
Colorado Other 840592369006 CAQH
Colorado Other BE41887 CAQH
Colorado Other 84059236906 CAQH
Colorado MEDICAID 01354125 CAQH

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