MEDICARE: NHI DAI PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1093253338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHI DAI PA

Provider Business Mailing Address
First Line	:	3930 HOWARD HUGHES PKWY STE 270
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3930 HOWARD HUGHES PKWY STE 270
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0906
Country	:	US
Telephone Number	:	800-834-2420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	05/26/2021

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Directions to “ NHI DAI PA” Practice Location

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