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General NPI Number Information
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NPI Number | 1750291266
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Entity Type | Individual
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Provider Name | DANIELLE BERTRAM NP
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Gender | Female
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 3218 W EDGEWOOD DR STE 500
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-6952
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Country | US
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Telephone | 573-415-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 LANGHAM DR
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City | COLUMBIA
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State | MO
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Zip | 65202-3342
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2026042202
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License Number State | MO
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