Provider Demographics
NPI:1417767435
Name:HEITZENRADER, NATHAN DAVIS
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAVIS
Last Name:HEITZENRADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 SOLSTICE DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7143
Mailing Address - Country:US
Mailing Address - Phone:775-843-0922
Mailing Address - Fax:
Practice Address - Street 1:18600 WEDGE PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3036
Practice Address - Country:US
Practice Address - Phone:775-784-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program