Provider Demographics
NPI:1144746256
Name:BERTRAM, CAROL M (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GRANADA CRES APT 17-4
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1251
Mailing Address - Country:US
Mailing Address - Phone:914-441-9521
Mailing Address - Fax:
Practice Address - Street 1:17 GRANADA CRES APT 17-4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1251
Practice Address - Country:US
Practice Address - Phone:914-441-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477915-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse