Healthcare Provider Details

I. General information

NPI: 1821627878
Provider Name (Legal Business Name): ANITA SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST
HENDERSON NV
89014-8771
US

IV. Provider business mailing address

375 N STEPHANIE ST
HENDERSON NV
89014-8771
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-9710
  • Fax:
Mailing address:
  • Phone: 702-799-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberIC-1716
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: