Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1982844007 |
---|---|
Provider Name | Bonnie Heidbrak |
First Address | Lafayette, CO 80026-9364 |
Second Address | Lafayette, CO 80026-9364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2009 |
Last Update Date | 02/03/2009 |