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General NPI Number Information
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NPI Number | 1518859149
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Entity Type | Individual
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Provider Name | HEATHER A THEADERMAN RN
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 6500 LONGLEY LN
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City | RENO
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State | NV
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Zip | 89511-2632
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Country | US
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Telephone | 775-799-7320
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Fax |
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Provider Business Mailing Address
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Address Line | 825 E PATRIOT BLVD APT 2058
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City | RENO
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State | NV
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Zip | 89511-1482
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Country | US
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Telephone | 919-332-0881
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 863800
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 163WG0100X
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Taxonomy Name | Gastroenterology Registered Nurse
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License Number | 041519007
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License Number State | IL
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