Provider Demographics
NPI:1164533717
Name:BERENS, CATHY L (MSNAPRN)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:L
Last Name:BERENS
Suffix:
Gender:F
Credentials:MSNAPRN
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:L
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3237
Mailing Address - Country:US
Mailing Address - Phone:307-265-1500
Mailing Address - Fax:307-265-1506
Practice Address - Street 1:940 EAST 3RD STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3200
Practice Address - Country:US
Practice Address - Phone:307-265-1500
Practice Address - Fax:307-265-1506
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22143346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313909OtherBCBS
WY113260100Medicaid
20712Medicare ID - Type Unspecified
WY313909OtherBCBS