Healthcare Provider Details

I. General information

NPI: 1972510691
Provider Name (Legal Business Name): LINDA LEA BERTRAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY 4D-140
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

1400 VFW PKWY 4D-140
WEST ROXBURY MA
02132-4927
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6773
  • Fax:
Mailing address:
  • Phone: 857-203-6773
  • Fax: 857-203-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number102755
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number102755
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: