MEDICARE: HEATHER MADSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1578950440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MADSEN

Provider Business Mailing Address
First Line	:	PO BOX 750686
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89136-0686
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6110 VILLA DE PICASSO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-5905
Country	:	US
Telephone Number	:	702-468-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2015
Last Update Date	:	04/18/2015

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Directions to “ HEATHER MADSEN ” Practice Location

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