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NPI Code Detail

MEDICARE: PANDORA WILLIAMS PHYSICIAN ASSISTANT

MEDICARE: PANDORA WILLIAMS PHYSICIAN ASSISTANT
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
1363A00000XPhysician Assistant1613AZ
2363A00000XPhysician AssistantPA1665NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093787210
Entity Type Code : Individual
Provider Name (Legal Business Name) : PANDORA WILLIAMS PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : PO BOX 98978
Second Line :
City : LAS VEGAS
State : NV
Zip : 89193-8978
Country : US
Telephone Number : 702-216-3346
Fax Number : 702-671-6883
Provider Business Practice Location Address
First Line : 4880 WYNN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5406
Country : US
Telephone Number : 702-871-5005
Fax Number : 702-871-1341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/21/2022

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Directions to “ PANDORA WILLIAMS PHYSICIAN ASSISTANT” Practice Location

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