Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Jun 24, 2019
License(s)
820182 (NV)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 7411198 | Chicago, IL 60674-1198 | 702-899-0595 |
| LOCATION | 6352 MEDICAL CENTER ST | Las Vegas, NV 89148-2413 | 702-899-0595 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.