Provider Demographics
NPI:1508821653
Name:ZINK, HEIDI L (CNM MS)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:L
Last Name:ZINK
Suffix:
Gender:F
Credentials:CNM MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 MERCADO ST STE 145
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7311
Mailing Address - Country:US
Mailing Address - Phone:970-247-5543
Mailing Address - Fax:970-247-5545
Practice Address - Street 1:1 MERCADO ST STE 145
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7311
Practice Address - Country:US
Practice Address - Phone:970-247-5543
Practice Address - Fax:970-247-5545
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO124354367A00000X
NM555367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83900039Medicaid
84-1491843OtherPRACTICE TAX ID
MZ1355381OtherFEDERAL CONTROLLED SUBSTANCE
CO50439251Medicaid
NM006984OtherNM BCBS PROVIDER ID
11749OtherACNM CERTIFICATION
COCO40986Medicare PIN