Healthcare Provider Details

I. General information

NPI: 1912033457
Provider Name (Legal Business Name): WENDY SUE AGARWAL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY SUE AGARWAL LPN

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2289 TURNER FALLS ST
HENDERSON NV
89044-1041
US

IV. Provider business mailing address

2289 TURNER FALLS ST
HENDERSON NV
89044-1041
US

V. Phone/Fax

Practice location:
  • Phone: 702-562-0299
  • Fax:
Mailing address:
  • Phone: 702-562-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN10515
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: