Provider Demographics
NPI:1962601757
Name:BERGENE, CONSTANCE ANN (REGISTER NURSE)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANN
Last Name:BERGENE
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:ANN
Other - Last Name:BERGENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTER NURSE
Mailing Address - Street 1:2800 S SYRACUSE WAY APT 7-202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4293
Mailing Address - Country:US
Mailing Address - Phone:303-918-2298
Mailing Address - Fax:
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:NURSING HOME CARE UNIT
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-393-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN438242163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation