Provider Demographics
NPI:1790383578
Name:MASSEY, HEATHER ROSE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROSE
Last Name:MASSEY
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 1:745 1/2 W 5TH ST # 745.5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4307
Mailing Address - Country:US
Mailing Address - Phone:775-857-5419
Mailing Address - Fax:
Practice Address - Street 1:745 1/2 W 5TH ST # 745.5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4307
Practice Address - Country:US
Practice Address - Phone:775-857-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide