Provider Demographics
NPI:1225503717
Name:WILSON, HEATHER (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 S YOSEMITE CT STE 2000
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1448
Mailing Address - Country:US
Mailing Address - Phone:720-387-8131
Mailing Address - Fax:720-387-8132
Practice Address - Street 1:6860 S YOSEMITE CT STE 2000
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1448
Practice Address - Country:US
Practice Address - Phone:720-387-8131
Practice Address - Fax:720-387-8132
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48404164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48404OtherNURSING