MEDICARE: ISABELLA HEREDIA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN89462	NV

General Provider Information

NPI Number	:	1639863921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLA HEREDIA RN

Provider Business Mailing Address
First Line	:	8434 E SHEA BLVD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6670
Country	:	US
Telephone Number	:	775-525-9353
Fax Number	:	866-497-4252

Provider Business Practice Location Address
First Line	:	6330 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3302
Country	:	US
Telephone Number	:	702-880-7002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	07/12/2023

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