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General NPI Number Information
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NPI Number | 1336655117
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Entity Type | Individual
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Provider Name | HEIDI NOLAN LMT
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Gender | Female
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 7380 S EASTERN AVE STE 109C
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City | LAS VEGAS
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State | NV
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Zip | 89123-1551
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Country | US
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Telephone | 702-553-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 1871 MISTY GLADE DR
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City | LAS VEGAS
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State | NV
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Zip | 89119-4596
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Country | US
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Telephone | 702-553-8233
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 4443
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License Number State | NV
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