Basic Information
| Provider Information | |||||||||
| NPI: | 1013248665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRIVER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10100 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814160008 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708747681 | ||||||||
| FaxNumber: | 9708746400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 114580 | CO | N | Nursing Service Providers | Registered Nurse | 363LF0000X | NP-3505 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367500000X | CRA-15064 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.