Provider Demographics
NPI:1295122596
Name:BERTKE, ANDREA MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:BERTKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-2566
Mailing Address - Country:US
Mailing Address - Phone:419-602-0054
Mailing Address - Fax:
Practice Address - Street 1:368 MILAN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-3106
Practice Address - Country:US
Practice Address - Phone:419-663-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.350815-COA 1163W00000X
OHCOA.17268-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse