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General NPI Number Information
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NPI Number | 1174824049
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Entity Type | Organization
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Legal Business Name | BERTRAND HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 402 MINOR AVE
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City | BERTRAND
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State | NE
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Zip | 68927-1234
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Country | US
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Telephone | 308-472-1472
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Fax | 308-472-1471
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Provider Business Mailing Address
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Address Line | 402 MINOR AVE PO BOX 444
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City | BERTRAND
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State | NE
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Zip | 68927-1234
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Country | US
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Telephone | 308-472-1472
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Fax | 308-472-1471
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | RUBY JOAN HOUCK
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Credential | APRN
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Telephone | 308-472-1472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 110285
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License Number State | NE
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