Basic Information
| Provider Information | |||||||||
| NPI: | 1285758235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBERHANSLI | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 MOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758833636 | ||||||||
| FaxNumber: | 7758822382 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 MOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758833636 | ||||||||
| FaxNumber: | 7758822382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 11/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LL1493 | NV | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | 13849 | NV | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | LL1493 | 01 | NV | MEDICAL LICENSE | OTHER | B08909725 | 01 | NV | DEA CERTIFICATE | OTHER |