Healthcare Provider Details

I. General information

NPI: 1346743184
Provider Name (Legal Business Name): HEATHER MARIE BLONDIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE HANKE

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SAINT ROSE PKWY STE 200
HENDERSON NV
89052-4841
US

IV. Provider business mailing address

2831 SAINT ROSE PKWY STE 200
HENDERSON NV
89052-4841
US

V. Phone/Fax

Practice location:
  • Phone: 702-329-0286
  • Fax: 702-991-3533
Mailing address:
  • Phone: 702-329-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336462
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO3127
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: