Provider Demographics
NPI:1245777077
Name:BERUBE, TRENA (RN BSN)
Entity Type:Individual
Prefix:
First Name:TRENA
Middle Name:
Last Name:BERUBE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 E 134TH DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1407
Mailing Address - Country:US
Mailing Address - Phone:303-916-0201
Mailing Address - Fax:
Practice Address - Street 1:16290 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1594
Practice Address - Country:US
Practice Address - Phone:303-699-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO184804163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care