Healthcare Provider Details

I. General information

NPI: 1811940315
Provider Name (Legal Business Name): HEIDI ANN VON NIEDA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BOISE AVE SUITE 410
LOVELAND CO
80538-5004
US

IV. Provider business mailing address

1627 E 18TH ST
LOVELAND CO
80538-4209
US

V. Phone/Fax

Practice location:
  • Phone: 970-820-2610
  • Fax: 970-820-2611
Mailing address:
  • Phone: 970-663-0135
  • Fax: 970-461-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1543
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number83368
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: