Provider Demographics
NPI:1487746368
Name:BROOKMAN, HEATHER ELISE (LAC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELISE
Last Name:BROOKMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 ARROYO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4909
Mailing Address - Country:US
Mailing Address - Phone:512-417-5692
Mailing Address - Fax:
Practice Address - Street 1:7380 S EASTERN AVE
Practice Address - Street 2:125
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1550
Practice Address - Country:US
Practice Address - Phone:702-562-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist