Healthcare Provider Details

I. General information

NPI: 1851793400
Provider Name (Legal Business Name): HEIDI S GAMBER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 MOHAWK DR
BOULDER CO
80303-3712
US

IV. Provider business mailing address

580 MOHAWK DR
BOULDER CO
80303-3712
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3800
  • Fax:
Mailing address:
  • Phone: 303-338-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number163W00000X
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: