Basic Information
| Provider Information | |||||||||
| NPI: | 1134626476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTRAM-REENTS | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BERTRAM | ||||||||
| OtherFirstName: | WHITNEY | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 520 S SIBLEY AVE | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553553030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206933233 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 520 S SIBLEY AVE | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553553030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206933233 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 10/24/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 66133 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 66133 | MN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.