Basic Information
| Provider Information | |||||||||
| NPI: | 1255593851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VAN SWERINGEN | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2121 E HARMONY ROAD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702215878 | ||||||||
| FaxNumber: | 9702213564 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 E HARMONY RD UNIT 330 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702215878 | ||||||||
| FaxNumber: | 9702213564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | DR.0058328 | CO | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | 11084A | WY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086X0206X | DR.0058328 | CO | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.