Provider Demographics
NPI:1053298141
Name:HERITAGE VALLEY WOUND CARE LLC
Entity type:Organization
Organization Name:HERITAGE VALLEY WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER TANAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-725-2261
Mailing Address - Street 1:10364 IRONWOOD PASS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-7151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10364 IRONWOOD PASS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-7151
Practice Address - Country:US
Practice Address - Phone:702-725-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty