Healthcare Provider Details

I. General information

NPI: 1326903592
Provider Name (Legal Business Name): ANGELINA L BERTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 2ND AVE SW APT B
MINOT ND
58701-3375
US

IV. Provider business mailing address

2529 2ND AVE SW APT B
MINOT ND
58701-3375
US

V. Phone/Fax

Practice location:
  • Phone: 701-818-7595
  • Fax:
Mailing address:
  • Phone: 701-818-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberBER936849
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: