Healthcare Provider Details

I. General information

NPI: 1457699498
Provider Name (Legal Business Name): DANIELLE MARIE BERTRAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W MERCURY ST STE 403
BUTTE MT
59701-1659
US

IV. Provider business mailing address

98 BURNING TREE LN
BUTTE MT
59701-3904
US

V. Phone/Fax

Practice location:
  • Phone: 406-491-6343
  • Fax: 406-723-5345
Mailing address:
  • Phone: 406-491-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1631449
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNUR-RN-LIC-67646
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0991635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: