Healthcare Provider Details

I. General information

NPI: 1154598050
Provider Name (Legal Business Name): HEIDI TERESA MIZONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI T VAN VOLKENBURGH

II. Dates (important events)

Enumeration Date: 05/11/2008
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 PARK MEADOWS DR
LONE TREE CO
80124-5425
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number168287
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0005697-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number168287
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0005697-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: