Healthcare Provider Details

I. General information

NPI: 1962601757
Provider Name (Legal Business Name): CONSTANCE ANN BERGENE REGISTER NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONNIE ANN BERGENE REGISTER NURSE

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST NURSING HOME CARE UNIT
DENVER CO
80220
US

IV. Provider business mailing address

2800 S SYRACUSE WAY APT 7-202
DENVER CO
80231-4293
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-4468
  • Fax:
Mailing address:
  • Phone: 303-918-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN438242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: