Individual
BONITA MARIE HEBERLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1555 N 17TH AVE, GREELEY, CO 80631-9117
(970) 304-6420
Mailing address
1555 N 17TH AVE, GREELEY, CO 80631-9117
(970) 304-6420
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
29796
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29796
NURSING LICENSE
CO
05
—
69057851
—
CO
Enumeration date
02/05/2007
Last updated
07/09/2007
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