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Individual

MS. HEIDI LEEA BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C.

Contact information

Practice address
3030 N CIRCLE DR STE 210, COLORADO SPRINGS, CO 80909
(719) 228-9440
(719) 228-9061
Mailing address
PO BOX 4659, SAN LUIS OBISPO, CA 93403-4659
(805) 544-7246
(805) 782-8097

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0002477
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
58821031
CO
Enumeration date
09/02/2006
Last updated
06/27/2018
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