Provider Demographics
NPI:1376623199
Name:BERTSCH, RONDA STELLER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:STELLER
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RONDA
Other - Middle Name:LOUISE
Other - Last Name:STELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2600 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55421
Mailing Address - Country:US
Mailing Address - Phone:612-706-2900
Mailing Address - Fax:612-706-2901
Practice Address - Street 1:2600 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4379
Practice Address - Country:US
Practice Address - Phone:612-706-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9678363A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP37610Medicare UPIN
MN1266004Medicare ID - Type Unspecified