Provider Demographics
NPI:1205504743
Name:NEIDER, BRANT (BC-HIS)
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:
Last Name:NEIDER
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 CHENEY DR W STE 130
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4099
Mailing Address - Country:US
Mailing Address - Phone:208-733-3340
Mailing Address - Fax:
Practice Address - Street 1:4560 S EASTERN AVE STE 16
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-650-3074
Practice Address - Fax:702-650-3127
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS-2665237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist