Provider Demographics
NPI:1073615001
Name:MUNCY, HEIDI JO (PA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:JO
Last Name:MUNCY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7625 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4567
Mailing Address - Country:US
Mailing Address - Phone:303-427-4075
Mailing Address - Fax:303-423-4185
Practice Address - Street 1:7625 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4567
Practice Address - Country:US
Practice Address - Phone:303-427-4075
Practice Address - Fax:303-423-4185
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00893501OtherRAIL ROAD MEDICARE
COP00893501OtherRAIL ROAD MEDICARE
COCOA103073Medicare PIN