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General NPI Number Information
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NPI Number | 1205504743
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Entity Type | Individual
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Provider Name | BRANT NEIDER BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 4560 S EASTERN AVE STE 16
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City | LAS VEGAS
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State | NV
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Zip | 89119-6182
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Country | US
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Telephone | 702-650-3074
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Fax | 702-650-3127
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Provider Business Mailing Address
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Address Line | 452 CHENEY DR W STE 130
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City | TWIN FALLS
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State | ID
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Zip | 83301-4099
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Country | US
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Telephone | 208-733-3340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HAS-2665
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License Number State | NV
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