Provider Demographics
NPI:1033263017
Name:JENKINS, HEIDI (CST, CFA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CST, CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 GREAT NORTHERN LOOP
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1738
Mailing Address - Country:US
Mailing Address - Phone:406-728-3811
Mailing Address - Fax:406-721-9141
Practice Address - Street 1:2802 GREAT NORTHERN LOOP
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1738
Practice Address - Country:US
Practice Address - Phone:406-728-3811
Practice Address - Fax:406-721-9141
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT83150246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical