Provider Demographics
NPI:1346668563
Name:BERTRAND, NORMA JEAN (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:NORMA JEAN
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MISS
Other - First Name:NORMA
Other - Middle Name:JEAN
Other - Last Name:RIVARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:3430 TULLY RD STE 20123
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0840
Mailing Address - Country:US
Mailing Address - Phone:209-324-3158
Mailing Address - Fax:
Practice Address - Street 1:3430 TULLY RD STE 20123
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0840
Practice Address - Country:US
Practice Address - Phone:209-324-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily