Provider Demographics
NPI:1366964660
Name:BERTRAND, MEREDITH JOYCE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JOYCE
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8082
Mailing Address - Country:US
Mailing Address - Phone:860-651-3519
Mailing Address - Fax:860-651-4133
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8082
Practice Address - Country:US
Practice Address - Phone:860-651-3519
Practice Address - Fax:860-651-4133
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-09
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109129163W00000X
CT7222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse