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General NPI Number Information
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NPI Number | 1780009787
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Entity Type | Individual
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Provider Name | TAMI D. HEARD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 217 ICY RIVER AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89031-6843
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Country | US
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Telephone | 702-720-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 217 ICY RIVER AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89031-6843
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Country | US
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Telephone | 702-720-9511
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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 | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number | 104046
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License Number State | NV
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