Healthcare Provider Details

I. General information

NPI: 1104725530
Provider Name (Legal Business Name): LAURIE BERTRAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 NORTHRIDGE RD
JOHNSTOWN OH
43031-9277
US

IV. Provider business mailing address

11195 PINEVIEW LN
MOUNT VERNON OH
43050-9249
US

V. Phone/Fax

Practice location:
  • Phone: 740-967-1401
  • Fax: 740-967-2140
Mailing address:
  • Phone: 614-600-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.309753
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: