Basic Information
| Provider Information | |||||||||
| NPI: | 1376623199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTSCH | ||||||||
| FirstName: | RONDA | ||||||||
| MiddleName: | STELLER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STELLER | ||||||||
| OtherFirstName: | RONDA | ||||||||
| OtherMiddleName: | LOUISE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2600 39TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | ST ANTHONY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127062900 | ||||||||
| FaxNumber: | 6127062901 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 39TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554214379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127062900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9678 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | 9678 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.