Healthcare Provider Details

I. General information

NPI: 1760804074
Provider Name (Legal Business Name): CHELSEE BERGIN RDH, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 1/2 B ROAD
GRAND JUNCTION CO
81503
US

IV. Provider business mailing address

2748 1/2 B ROAD
GRAND JUNCTION CO
81503
US

V. Phone/Fax

Practice location:
  • Phone: 970-640-5093
  • Fax:
Mailing address:
  • Phone: 970-640-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number906572
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number724392
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: