Provider Demographics
NPI:1891364600
Name:BERTHIAUME, CARLEY JEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:JEANNE
Last Name:BERTHIAUME
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Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:4300 MARKETPOINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:4300 MARKETPOINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-835-9880
Practice Address - Fax:952-857-1554
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2023-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN13710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant