Provider Demographics
NPI:1205640489
Name:BERNTSEN, ERIN ANNE (ACNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANNE
Last Name:BERNTSEN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ANNE
Other - Last Name:GILLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1507 JOSHUA TREE ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-7300
Mailing Address - Country:US
Mailing Address - Phone:916-513-8703
Mailing Address - Fax:
Practice Address - Street 1:1200 B GALE WILSON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3587
Practice Address - Country:US
Practice Address - Phone:707-646-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033845363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care