Healthcare Provider Details

I. General information

NPI: 1043865793
Provider Name (Legal Business Name): ANGELINA MARIE HEUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 BRIARGATE PARKWAY
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

22652 E BELLEWOOD DR
CENTENNIAL CO
80015-6789
US

V. Phone/Fax

Practice location:
  • Phone: 618-980-2038
  • Fax:
Mailing address:
  • Phone: 618-980-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1652122
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPN.0994907-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: