Provider Demographics
NPI:1073863437
Name:HEINLEIN, JOHN (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HEINLEIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 OLD HOT SPRINGS ROAD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0782
Mailing Address - Country:US
Mailing Address - Phone:775-687-5162
Mailing Address - Fax:775-687-5745
Practice Address - Street 1:1665 OLD HOT SPRINGS ROAD
Practice Address - Street 2:SUITE 157
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0782
Practice Address - Country:US
Practice Address - Phone:775-687-5162
Practice Address - Fax:775-687-5745
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN25787163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health