Healthcare Provider Details

I. General information

NPI: 1235064676
Provider Name (Legal Business Name): NOLAN TATRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 KIETZKE LN STE O260
RENO NV
89502-5046
US

IV. Provider business mailing address

2875 IDLEWILD DR APT 34
RENO NV
89509-1123
US

V. Phone/Fax

Practice location:
  • Phone: 775-360-6115
  • Fax:
Mailing address:
  • Phone: 775-502-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT.13680
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: