| Doctor Name: | SHELLY BERTRAM |
| NPI Number: | 1003284027 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | RN097015 |
| Business Practice Address: | 9261 W Van Buren St Tolleson, AZ - 853532941 |
| Business Phone Number: | 6239369740 |
| Business Fax Number: | |
| Mailing Address: | 9261 W Van Buren St, TOLLESON |
| State: | AZ |
| Postal Code: | 853532941 |
| Phone Number: | 6239369740 |
| Fax Number: | |
| NPI Enumeration Date: | 09/08/2015 |
| NPI Last Update Date: | 09/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | RN097015 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |