Healthcare Provider Details

I. General information

NPI: 1427491323
Provider Name (Legal Business Name): IMMUNIZE NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 NEIL RD STE 103
RENO NV
89502-6546
US

IV. Provider business mailing address

5250 NEIL RD STE 103
RENO NV
89502-6546
US

V. Phone/Fax

Practice location:
  • Phone: 775-870-4338
  • Fax:
Mailing address:
  • Phone: 775-870-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: HEIDI S PARKER
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 775-870-4338