Healthcare Provider Details

I. General information

NPI: 1851523971
Provider Name (Legal Business Name): NEVADA STATE HEALTH DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 1ST STREET
HAWTHORNE NV
89415
US

IV. Provider business mailing address

4150 TECHNOLOGY WAY SUITE 101
CARSON CITY NV
89706
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-3657
  • Fax: 775-945-2039
Mailing address:
  • Phone: 775-684-5900
  • Fax: 775-684-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA S GRAHAM
Title or Position: DIRECTOR, FAR PROGRAM
Credential: R.N., L.N.C.
Phone: 775-684-4208