Healthcare Provider Details

I. General information

NPI: 1427869304
Provider Name (Legal Business Name): CIRK RUSSELL BEJNAR CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WALLYS WAY
SOCORRO NM
87801-5134
US

IV. Provider business mailing address

9 WALLYS WAY
SOCORRO NM
87801-5134
US

V. Phone/Fax

Practice location:
  • Phone: 575-418-8598
  • Fax:
Mailing address:
  • Phone: 575-418-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberNM222384130E
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: