Healthcare Provider Details

I. General information

NPI: 1972086973
Provider Name (Legal Business Name): MARIE MARLENE BERTRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 W 62ND PL APT 202
HIALEAH FL
33016-5909
US

IV. Provider business mailing address

2775 W 62ND PL APT 202
HIALEAH FL
33016-5909
US

V. Phone/Fax

Practice location:
  • Phone: 786-873-5883
  • Fax:
Mailing address:
  • Phone: 786-873-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: