Doctor Name: | MISS STACY M BERTRAM |
NPI Number: | 1154776102 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPN |
License Number: | 274466 |
Business Practice Address: | 300 Gramatan Ave Apt G85 Mount Vernon, NY - 105523245 |
Business Phone Number: | 9144371455 |
Business Fax Number: | |
Mailing Address: | 300 Gramatan Ave, Apt G85 MOUNT VERNON |
State: | NY |
Postal Code: | 105523245 |
Phone Number: | 9144371455 |
Fax Number: | |
NPI Enumeration Date: | 04/27/2016 |
NPI Last Update Date: | 04/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 164W00000X |
License Number: | 274466 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Licensed Practical Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |