Healthcare Provider Details

I. General information

NPI: 1043132053
Provider Name (Legal Business Name): WILLIAM BRYANT BERTINO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 STEELHAMMER DR
CENTRALIA WA
98531-1532
US

IV. Provider business mailing address

2330 ALLEGHENY DR APT D
COLORADO SPRINGS CO
80919-3058
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9044
  • Fax: 360-736-0689
Mailing address:
  • Phone: 360-330-9044
  • Fax: 360-736-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1692066
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: