Active NPI
Heather Ponicsan
- Registered Nurse
- Boulder, CO
National Provider Identifier
1427428168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 1629259
- Practice address
- 1333 Iris Ave
Boulder, CO 80304-2226 - Phone
- (303) 443-8500
- NPI assigned
- Oct 6, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 1629259 | CO | Primary |
Addresses
Primary practice location
1333 Iris Ave
Boulder, CO 80304-2226
Mailing address
5735 W 118TH Ave
Westminster, CO 80020-5980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1629259 | CO | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444089600000",
"number": "1427428168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5735 W 118TH AVE",
"city": "WESTMINSTER",
"state": "CO",
"postal_code": "800205980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 IRIS AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803042226",
"telephone_number": "303-443-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONICSAN",
"first_name": "HEATHER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-06",
"last_updated": "2015-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CO",
"license": "1629259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.