Healthcare Provider Details

I. General information

NPI: 1023206323
Provider Name (Legal Business Name): HEIDI MCNEELY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4857 S BROADWAY
ENGLEWOOD CO
80113-6806
US

IV. Provider business mailing address

4857 S BROADWAY
ENGLEWOOD CO
80113-6806
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-7115
  • Fax: 303-761-1528
Mailing address:
  • Phone: 303-783-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number128052
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: