Provider Demographics
NPI:1548408370
Name:BERTOK, DIANDRA (CNP)
Entity Type:Individual
Prefix:
First Name:DIANDRA
Middle Name:
Last Name:BERTOK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 630
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2123
Mailing Address - Fax:419-291-6972
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 630
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2123
Practice Address - Fax:419-291-6972
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10547-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily