Provider Demographics
NPI:1033485545
Name:BERTRAND, MONIQUE TERESE (LPN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:TERESE
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 GREENE AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:424 GREENE AVE
Practice Address - Street 2:APT 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1109
Practice Address - Country:US
Practice Address - Phone:347-840-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297619-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse