Provider Demographics
NPI:1891209144
Name:DENMARK, BERTA I (RN)
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:I
Last Name:DENMARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 COLORADO DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4355
Mailing Address - Country:US
Mailing Address - Phone:254-319-5195
Mailing Address - Fax:
Practice Address - Street 1:8300 BOONE BLVD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2626
Practice Address - Country:US
Practice Address - Phone:703-714-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-23
Last Update Date:2017-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686734163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse