Provider Demographics
NPI:1144561457
Name:BERTTUNEN, COLLEEN LESLIE (RN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LESLIE
Last Name:BERTTUNEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15049 368TH STREET
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464
Mailing Address - Country:US
Mailing Address - Phone:218-849-6130
Mailing Address - Fax:218-631-4228
Practice Address - Street 1:15049 368TH STREET
Practice Address - Street 2:
Practice Address - City:MENAHGA
Practice Address - State:MN
Practice Address - Zip Code:56464
Practice Address - Country:US
Practice Address - Phone:218-849-6130
Practice Address - Fax:218-631-4228
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191660-1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management