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General NPI Number Information
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NPI Number | 1770691651
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Entity Type | Individual
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Provider Name | NORMAN LEO BERTHIAUME FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 1200 ROBERTS AVE NE
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City | COOPERSTOWN
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State | ND
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Zip | 58425-7101
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Country | US
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Telephone | 701-797-2221
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Fax | 701-797-2457
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Provider Business Mailing Address
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Address Line | 1200 ROBERTS AVE NE
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City | COOPERSTOWN
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State | ND
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Zip | 58425-7101
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Country | US
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Telephone | 701-797-2221
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Fax | 701-797-2457
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R015780
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | R34592
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License Number State | ND
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