Healthcare Provider Details

I. General information

NPI: 1558568246
Provider Name (Legal Business Name): NANCY R HENDERSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 LAKESIDE DR STE A
RENO NV
89509
US

IV. Provider business mailing address

501 HAMMILL LN STE A
RENO NV
89511-1004
US

V. Phone/Fax

Practice location:
  • Phone: 775-682-4000
  • Fax: 775-682-4003
Mailing address:
  • Phone: 775-682-4000
  • Fax: 775-682-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD 19 AND HAS 64
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-019
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberHAS64
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: