Healthcare Provider Details

I. General information

NPI: 1972419190
Provider Name (Legal Business Name): AMI ANNA AIZAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2697
US

IV. Provider business mailing address

2298 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2697
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4401
  • Fax:
Mailing address:
  • Phone: 702-869-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number897210
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: