Provider Demographics
NPI:1215035373
Name:BERTRAM, PAULA M (NP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-7851
Mailing Address - Country:US
Mailing Address - Phone:530-626-7348
Mailing Address - Fax:
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:#3700
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-984-7840
Practice Address - Fax:916-983-8511
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily