Provider Demographics
NPI:1811153745
Name:COLE BERGERON, BRENDA SUE (RN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:COLE BERGERON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:855 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-1304
Mailing Address - Country:US
Mailing Address - Phone:603-752-3428
Mailing Address - Fax:
Practice Address - Street 1:855 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-1304
Practice Address - Country:US
Practice Address - Phone:603-752-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0043020163W00000X
NH036961-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse