Healthcare Provider Details

I. General information

NPI: 1700749959
Provider Name (Legal Business Name): DAYNA BERGMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W STE 212, BLDG C
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W ATT: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 385-203-2720
  • Fax: 801-375-4237
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14258508-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: