Healthcare Provider Details

I. General information

NPI: 1881492809
Provider Name (Legal Business Name): HEATHER LYN NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E BROADWAY ST
NEEDLES CA
92363-3815
US

IV. Provider business mailing address

1060 E BROADWAY ST
NEEDLES CA
92363-3815
US

V. Phone/Fax

Practice location:
  • Phone: 626-753-5298
  • Fax:
Mailing address:
  • Phone: 626-753-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-XNPVHB
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: