1154598050 NPI number — HEIDI TERESA MIZONES FNP

Table of content: (NPI 1922294289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154598050 NPI number — HEIDI TERESA MIZONES FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIZONES
Provider First Name:
HEIDI
Provider Middle Name:
TERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN VOLKENBURGH
Provider Other First Name:
HEIDI
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154598050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10350 E DAKOTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80247-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10240 PARK MEADOWS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-338-4545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  168287 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APN.0005697-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 168287 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN.0005697-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1154598050 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36351288 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3109324 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CO306359 . This is a "RIA MEDICARE TBLZR" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".