Healthcare Provider Details

I. General information

NPI: 1396259271
Provider Name (Legal Business Name): NICOLE BERCKEFELDT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

3791 WINDRIVER TRL
CASTLE ROCK CO
80109-7923
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-2121
  • Fax:
Mailing address:
  • Phone: 720-280-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0197444
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: