Provider Demographics
NPI:1013179092
Name:NADER, HEIDI
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:NADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5608
Mailing Address - Country:US
Mailing Address - Phone:253-376-3456
Mailing Address - Fax:
Practice Address - Street 1:17528 MERIDIAN E
Practice Address - Street 2:STE 209
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6286
Practice Address - Country:US
Practice Address - Phone:253-445-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist