1669969424 NPI number — ALESHA AVIS HEINZ

Table of content: ALESHA AVIS HEINZ (NPI 1669969424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669969424 NPI number — ALESHA AVIS HEINZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEINZ
Provider First Name:
ALESHA
Provider Middle Name:
AVIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669969424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 W CHARLESTON BLVD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-671-2273
Provider Business Mailing Address Fax Number:
702-385-9399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57950 LEAVENWORTH STREET, SUITE 4E1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCONNELL AFB
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67221-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-759-5116
Provider Business Practice Location Address Fax Number:
316-759-6553
Provider Enumeration Date:
04/17/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)