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NPI Code Detail

MEDICARE: HEATHER ANN BAKKER

MEDICARE: HEATHER ANN BAKKER
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
1171W00000XContractor5394NV

General Provider Information

NPI Number : 1770795007
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER ANN BAKKER
Provider Business Mailing Address
First Line : 8000 SPRING MOUNTAIN RD
Second Line : APT 2109
City : LAS VEGAS
State : NV
Zip : 89117-3908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2625 E SAINT LOUIS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4200
Country : US
Telephone Number : 702-799-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 07/08/2007

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Directions to “ HEATHER ANN BAKKER ” Practice Location

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