Individual
BERTRAM PRIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1640 REDSTONE CENTER DR, PARK CITY, UT 84098-7605
(214) 264-9711
Mailing address
8931 PARDEE RD, TAYLOR, MI 48180-2741
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111838
MI
Other
Enumeration date
03/16/2020
Last updated
03/16/2020
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