Basic Information
Provider Information
NPI: 1003853151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SABOL
FirstName: HEATHER
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WILLIAMS
OtherFirstName: HEATHER
OtherMiddleName: JEAN
OtherNamePrefix: MR.
OtherNameSuffix:  
OtherCredential: MSN, ANP
OtherLastNameType: 1
Mailing Information
Address1: 1000 LOCUST ST
Address2:  
City: RENO
State: NV
PostalCode: 895022597
CountryCode: US
TelephoneNumber: 7757867200
FaxNumber: 7753372238
Practice Location
Address1: 1000 LOCUST ST
Address2:  
City: RENO
State: NV
PostalCode: 895022597
CountryCode: US
TelephoneNumber: 7757867200
FaxNumber: 7753372238
Other Information
ProviderEnumerationDate: 05/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN1006635DCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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