Healthcare Provider Details

I. General information

NPI: 1568531234
Provider Name (Legal Business Name): HEIDI GILLESPIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI MANZONIE PA-C

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20270 E SMOKY HILL RD
CENTENNIAL CO
80015-3138
US

IV. Provider business mailing address

750 W HAMPDEN AVE STE 105
ENGLEWOOD CO
80110-2167
US

V. Phone/Fax

Practice location:
  • Phone: 303-680-0664
  • Fax: 303-693-2043
Mailing address:
  • Phone: 303-945-3299
  • Fax: 303-945-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number568
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3796
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: