Healthcare Provider Details

I. General information

NPI: 1821473315
Provider Name (Legal Business Name): EARL NISWONGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 W HORIZON RIDGE PKWY
HENDERSON NV
89012-4833
US

IV. Provider business mailing address

290 SUTTON HILLS PL
HENDERSON NV
89002-9745
US

V. Phone/Fax

Practice location:
  • Phone: 702-376-2838
  • Fax:
Mailing address:
  • Phone: 702-376-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: