Provider Demographics
NPI:1942303508
Name:BERTRAND, THERESE BIENVENU (FNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:BIENVENU
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:#225
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5884
Mailing Address - Country:US
Mailing Address - Phone:281-469-8414
Mailing Address - Fax:281-469-6213
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:#225
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:281-469-8414
Practice Address - Fax:281-469-6213
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7202OtherBCBS
Q23354Medicare UPIN
TXNP7202OtherBCBS