Provider Demographics
NPI:1639606080
Name:HIMLER, HEIDI LYNETTE (MPH RD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNETTE
Last Name:HIMLER
Suffix:
Gender:F
Credentials:MPH RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E CRYSTAL CANYON CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-6816
Mailing Address - Country:US
Mailing Address - Phone:775-771-0186
Mailing Address - Fax:
Practice Address - Street 1:124 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1726
Practice Address - Country:US
Practice Address - Phone:775-771-0186
Practice Address - Fax:844-816-1888
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1060758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV35808-DI-1OtherDIETITIAN LICENSURE