Individual
MRS. SHANA MARIE BERTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11366
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306866918
—
MI
05
—
1306866918
—
WI
05
—
30337108
—
NH
Enumeration date
07/20/2006
Last updated
10/15/2013
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