Provider Demographics
NPI:1841516085
Name:BERTLING, GLENN A (CRNFA)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:BERTLING
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-227-7702
Mailing Address - Fax:419-227-7991
Practice Address - Street 1:951 COMMERCE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4040
Practice Address - Country:US
Practice Address - Phone:419-227-7702
Practice Address - Fax:419-227-7991
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH084166163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant