Provider Demographics
NPI:1912197906
Name:BERTILRUD, JOAN Y (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:Y
Last Name:BERTILRUD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14818 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:GREENBUSH
Mailing Address - State:MN
Mailing Address - Zip Code:56726-9380
Mailing Address - Country:US
Mailing Address - Phone:701-730-0482
Mailing Address - Fax:218-782-4191
Practice Address - Street 1:14818 COUNTY ROAD 4
Practice Address - Street 2:
Practice Address - City:GREENBUSH
Practice Address - State:MN
Practice Address - Zip Code:56726-9380
Practice Address - Country:US
Practice Address - Phone:701-730-0482
Practice Address - Fax:218-782-4191
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 072313-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse