Provider Demographics
NPI:1972272037
Name:WALNDIM, BERTHA NJIA (RN)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:NJIA
Last Name:WALNDIM
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 1:7691 CENTRAL AVENUE NE, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3560
Mailing Address - Country:US
Mailing Address - Phone:763-572-2390
Mailing Address - Fax:763-574-2459
Practice Address - Street 1:7691 CENTRAL AVENUE NE, SUITE 102
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3560
Practice Address - Country:US
Practice Address - Phone:763-572-2390
Practice Address - Fax:763-574-2459
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2261957163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse