Healthcare Provider Details

I. General information

NPI: 1487341889
Provider Name (Legal Business Name): BETHANY HEUN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY POLING

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4856 INNOVATION DR
FORT COLLINS CO
80525-5539
US

IV. Provider business mailing address

4856 INNOVATION DR
FORT COLLINS CO
80525-5539
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4200
  • Fax: 844-270-1824
Mailing address:
  • Phone: 970-494-4200
  • Fax: 844-270-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1687653
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: