Provider Demographics
NPI:1083450928
Name:HEATH, CIARA LYN (RD)
Entity type:Individual
Prefix:MISS
First Name:CIARA
Middle Name:LYN
Last Name:HEATH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9393 SHELBY GENE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-8359
Mailing Address - Country:US
Mailing Address - Phone:602-989-3752
Mailing Address - Fax:
Practice Address - Street 1:9393 SHELBY GENE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-8359
Practice Address - Country:US
Practice Address - Phone:602-989-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40475-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered