Provider Demographics
NPI:1255057246
Name:HEATHMON, PAMELA L
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:HEATHMON
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 1:1224 RAINY SKY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3710
Mailing Address - Country:US
Mailing Address - Phone:702-350-5719
Mailing Address - Fax:
Practice Address - Street 1:1224 RAINY SKY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3710
Practice Address - Country:US
Practice Address - Phone:702-350-5719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician