Healthcare Provider Details

I. General information

NPI: 1619630860
Provider Name (Legal Business Name): HORNELL HEARN PROSTHETIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 S JONES BLVD STE 140
LAS VEGAS NV
89146-5641
US

IV. Provider business mailing address

1120 SAFFEX ROSE AVE
HENDERSON NV
89052-8720
US

V. Phone/Fax

Practice location:
  • Phone: 800-736-8276
  • Fax: 469-844-2072
Mailing address:
  • Phone: 775-232-8093
  • Fax: 469-844-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: