Provider Demographics
NPI:1851568000
Name:BERT, TERESA CATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:CATHERINE
Last Name:BERT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RANDALL SQUARE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-331-7178
Mailing Address - Fax:401-331-6180
Practice Address - Street 1:1 RANDALL SQUARE
Practice Address - Street 2:SUITE 205
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-331-7178
Practice Address - Fax:401-331-6180
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI23412363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health