MEDICARE: MAUDE BERTRESSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	472214-1	NY

General Provider Information

NPI Number	:	1043678493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUDE BERTRESSE

Provider Business Mailing Address
First Line	:	1461 E 91ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1752 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-2811
Country	:	US
Telephone Number	:	646-686-0460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2016
Last Update Date	:	01/31/2016

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Directions to “ MAUDE BERTRESSE ” Practice Location

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