Healthcare Provider Details

I. General information

NPI: 1245777077
Provider Name (Legal Business Name): TRENA BERUBE RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16290 E QUINCY AVE
AURORA CO
80015-1594
US

IV. Provider business mailing address

3591 E 134TH DR
THORNTON CO
80241-1407
US

V. Phone/Fax

Practice location:
  • Phone: 303-699-3811
  • Fax:
Mailing address:
  • Phone: 303-916-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number184804
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: