MEDICARE: DENICE RENEE HEBERLY R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0800X	Orthopedic Registered Nurse	72967	CO

General Provider Information

NPI Number	:	1669647061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENICE RENEE HEBERLY R.N.

Provider Business Mailing Address
First Line	:	6011 E WOODMEN RD STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2603
Country	:	US
Telephone Number	:	719-574-8383
Fax Number	:	719-574-8548

Provider Business Practice Location Address
First Line	:	6011 E WOODMEN RD STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2603
Country	:	US
Telephone Number	:	719-574-8383
Fax Number	:	719-574-8548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	08/04/2010

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