Basic Information
| Provider Information | |||||||||
| NPI: | 1114692555 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BERTEAU-PAVY | ||||||||
| FirstName: | DAPHNEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6004 FARMSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591016775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038801842 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3311 RIVERBEND DR | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974778800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414844332 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2021 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA206406 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207RC0000X | 206406 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.