| Doctor Name: | HEIDI JENKINS |
| NPI Number: | 1033263017 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CST, CFA |
| License Number: | 83150 |
| Business Practice Address: | 2802 Great Northern Loop Missoula, MT - 598081738 |
| Business Phone Number: | 4067283811 |
| Business Fax Number: | 4067219141 |
| Mailing Address: | 2802 Great Northern Loop, MISSOULA |
| State: | MT |
| Postal Code: | 598081738 |
| Phone Number: | 4067283811 |
| Fax Number: | 4067219141 |
| NPI Enumeration Date: | 01/23/2007 |
| NPI Last Update Date: | 12/04/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZA2600X |
| License Number: | 83150 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Art, Medical |
| Taxonomy Definition: | |