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General NPI Number Information
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NPI Number | 1316086556
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Entity Type | Individual
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Provider Name | BONITA MARIE HEBERLEIN
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1555 N 17TH AVE
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City | GREELEY
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State | CO
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Zip | 80631-9117
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Country | US
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Telephone | 970-304-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 N 17TH AVE
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City | GREELEY
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State | CO
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Zip | 80631-9117
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Country | US
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Telephone | 970-304-6420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 29796
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License Number State | CO
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