Provider Demographics
NPI:1063278323
Name:NELSON, BERLINE PASSIUS
Entity type:Individual
Prefix:
First Name:BERLINE
Middle Name:PASSIUS
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 NEW CENTER PT # 1014
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2806
Mailing Address - Country:US
Mailing Address - Phone:719-755-2396
Mailing Address - Fax:
Practice Address - Street 1:10250 INTREPID WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80925-8441
Practice Address - Country:US
Practice Address - Phone:561-788-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle