Roark, Bertha Ann
Roark, Bertha Ann is an individual health care provider with primary practice located at 310 La Jara St , Bloomfield NM 87413-6626. She recently has only one registered license in Nursing Service Providers / School, which is considered as her primary health care specialty. Roark, Bertha Ann can be contacted via phone (505) 634-3673.Contact Information
Primary practice address
310 La Jara St
Bloomfield NM 87413-6626
Phone: (505) 634-3673
Fax: (505) 634-3675
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / School | 163WS0200X | R18502 | New Mexico |
Profile Details
| NPI number | 1750598835 |
|---|---|
| LBN Legal business name | Roark, Bertha Ann |
| Credentials | Registered Nurse (RN) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 17th, 2007 |
| Last updated | Jul 9th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750598835 | NPPES |
| New Mexico | MEDICAID | 64434826 |
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