MEDICARE: MS. ANN ELIZABETH HETRICK RNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	40551	CO
2	363LW0102X	Women's Health Nurse Practitioner	102206	MO
3	363LW0102X	Women's Health Nurse Practitioner		WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396786810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN ELIZABETH HETRICK RNC

Provider Business Mailing Address
First Line	:	2883 S LOCUST ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2706
Country	:	US
Telephone Number	:	303-813-7633
Fax Number	:	303-813-7673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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