Healthcare Provider Details

I. General information

NPI: 1881050235
Provider Name (Legal Business Name): BERKLEY NIELSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
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

9403 GRAY CT
WESTMINSTER CO
80031-6534
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0170560
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: