Healthcare Provider Details

I. General information

NPI: 1669647061
Provider Name (Legal Business Name): DENICE RENEE HEBERLY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 E WOODMEN RD STE 120
COLORADO SPRINGS CO
80923-2603
US

IV. Provider business mailing address

6011 E WOODMEN RD STE 120
COLORADO SPRINGS CO
80923-2603
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-8383
  • Fax: 719-574-8548
Mailing address:
  • Phone: 719-574-8383
  • Fax: 719-574-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number72967
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: