Individual
HEATHER DAMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
822 W 4TH ST, LEADVILLE, CO 80461-3861
(719) 486-0230
Mailing address
266 ALPINE DR, LEADVILLE, CO 80461-2021
(970) 485-9366
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2250
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40932061
—
CO
Enumeration date
02/17/2006
Last updated
02/12/2010
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