Provider Demographics
NPI:1306306840
Name:ENABULELE, HEATHER NOELL
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NOELL
Last Name:ENABULELE
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:PO BOX 20232
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-0232
Mailing Address - Country:US
Mailing Address - Phone:775-443-0377
Mailing Address - Fax:
Practice Address - Street 1:5234 SLOPE DR
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-7942
Practice Address - Country:US
Practice Address - Phone:775-221-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNRS86374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide