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NPI Code Detail

MEDICARE: PAIGE BERGEN AANESTAD

MEDICARE: PAIGE BERGEN AANESTAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1013661479
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAIGE BERGEN AANESTAD
Provider Business Mailing Address
First Line : 5251 JAMES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55430-3445
Country : US
Telephone Number : 612-499-5934
Fax Number :
Provider Business Practice Location Address
First Line : 5251 JAMES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55430-3445
Country : US
Telephone Number : 612-499-5934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2022
Last Update Date : 02/04/2022

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Directions to “ PAIGE BERGEN AANESTAD ” Practice Location

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