Provider Demographics
NPI:1972563724
Name:AUGST, HEATHER FRANCES BARE (OTR)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:FRANCES BARE
Last Name:AUGST
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:FRANCES
Other - Last Name:BARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1375 N FORD ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1349
Mailing Address - Country:US
Mailing Address - Phone:858-405-8402
Mailing Address - Fax:
Practice Address - Street 1:311 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3979
Practice Address - Country:US
Practice Address - Phone:303-440-2154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3048174400000X
CO2816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0030480OtherBLUE SHIELD ID