Healthcare Provider Details

I. General information

NPI: 1962588418
Provider Name (Legal Business Name): CYNTHIA MERRIAM BERTRAND REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S JEFFERSON ST
ABBEVILLE LA
70510-5906
US

IV. Provider business mailing address

25934 CHESTNUT RD
KAPLAN LA
70548-6854
US

V. Phone/Fax

Practice location:
  • Phone: 337-898-5713
  • Fax: 337-898-5816
Mailing address:
  • Phone: 337-536-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number56190
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: