| Doctor Name: | ASHLEY NICOLE BERTRAM |
| NPI Number: | 1053714642 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA057218 |
| Business Practice Address: | 529 Sunflower Dr Du Bois, PA - 158012378 |
| Business Phone Number: | 8143711510 |
| Business Fax Number: | |
| Mailing Address: | 529 Sunflower Dr, DU BOIS |
| State: | PA |
| Postal Code: | 158012378 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2014 |
| NPI Last Update Date: | 09/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA057218 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |