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General NPI Number Information
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NPI Number | 1669182234
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Entity Type | Individual
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Provider Name | MADISON ALEXIS BERTRAM APRN
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 100 AQUA WAY APT 209
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City | NEWPORT
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State | KY
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Zip | 41071-2296
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Country | US
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Telephone | 888-279-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 100 AQUA WAY APT 209
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City | NEWPORT
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State | KY
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Zip | 41071-2296
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Country | US
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Telephone | 859-446-8290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0032171
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License Number State | OH
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