Provider Demographics
NPI:1164405841
Name:HEISTERMAN, NANCY JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JOAN
Last Name:HEISTERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 AUTUMN SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1698
Mailing Address - Country:US
Mailing Address - Phone:702-653-2890
Mailing Address - Fax:702-653-2549
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:AMDS/SGPT
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-2890
Practice Address - Fax:702-653-2549
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily