Provider Demographics
NPI:1518231505
Name:BERTALMIO, JULIANNE DESCHLER (APN)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:DESCHLER
Last Name:BERTALMIO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:DESCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1460 N. HALSTED STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642
Mailing Address - Country:US
Mailing Address - Phone:312-279-8900
Mailing Address - Fax:708-424-1715
Practice Address - Street 1:1460 N. HALSTED STREET
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642
Practice Address - Country:US
Practice Address - Phone:312-279-8900
Practice Address - Fax:708-424-1715
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041369484163WP0200X
IL209009374363LP0200X
IL209.009374 041.36948363LP0200X
IL277000783363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209009374OtherAPN