Provider Demographics
NPI:1588652762
Name:HECKER, CARRIE THERESE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:THERESE
Last Name:HECKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 RICHMOND DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5925
Mailing Address - Country:US
Mailing Address - Phone:970-213-2714
Mailing Address - Fax:
Practice Address - Street 1:924 RICHMOND DR UNIT 2
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5925
Practice Address - Country:US
Practice Address - Phone:970-213-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94483367500000X
COCRA-2426367500000X
FLARNP9201533367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07944838Medicaid
COP00099460Medicare PIN
COCOA102254Medicare PIN