Provider Demographics
NPI:1427869304
Name:BEJNAR, CIRK RUSSELL (CNA)
Entity type:Individual
Prefix:MR
First Name:CIRK
Middle Name:RUSSELL
Last Name:BEJNAR
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WALLYS WAY
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-5134
Mailing Address - Country:US
Mailing Address - Phone:575-418-8598
Mailing Address - Fax:
Practice Address - Street 1:9 WALLYS WAY
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-5134
Practice Address - Country:US
Practice Address - Phone:575-418-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NMNM222384130E3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM222384130EOtherNEW MEXICO NURSE AIDE PROGRAM