Provider Demographics
NPI:1760804074
Name:BERGIN, CHELSEE (RDH, CNA)
Entity Type:Individual
Prefix:
First Name:CHELSEE
Middle Name:
Last Name:BERGIN
Suffix:
Gender:F
Credentials:RDH, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 1/2 B ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503
Mailing Address - Country:US
Mailing Address - Phone:970-640-5093
Mailing Address - Fax:
Practice Address - Street 1:2748 1/2 B ROAD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503
Practice Address - Country:US
Practice Address - Phone:970-640-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906572124Q00000X
CO724392376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No376K00000XNursing Service Related ProvidersNurse's Aide