Provider Demographics
NPI:1619630860
Name:HEARN, HORNELL (PROSTHETIST)
Entity Type:Individual
Prefix:
First Name:HORNELL
Middle Name:
Last Name:HEARN
Suffix:
Gender:M
Credentials:PROSTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SAFFEX ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8720
Mailing Address - Country:US
Mailing Address - Phone:775-232-8093
Mailing Address - Fax:469-844-2072
Practice Address - Street 1:2780 S JONES BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5641
Practice Address - Country:US
Practice Address - Phone:800-736-8276
Practice Address - Fax:469-844-2072
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DECPO04014OtherABC CERTIFICATE