Individual
MR. BRUCE EDWARD HERTZENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICENSED SURG ASSIST
Contact information
Practice address
5130 HOLLY LN N, #3, PLYMOUTH, MN 55446-1772
(763) 694-9248
(763) 694-0293
Mailing address
5130 HOLLY LN N, #3, PLYMOUTH, MN 55446-1772
(763) 694-9248
(763) 694-0293
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA00271
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066759
CERT. SURGICAL TECHNICIAN
MN
01
—
89003
CERT. FIRST ASSISTANT
MN
01
—
SA00271
LIC. SURGICAL ASSISTANT
TX
Enumeration date
11/19/2005
Last updated
07/08/2007
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