Healthcare Provider Details

I. General information

NPI: 1518262989
Provider Name (Legal Business Name): KRISTINA SHURTLEFF MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 S WATER ST STE 200
HENDERSON NV
89015-7223
US

IV. Provider business mailing address

35 E HORIZON RIDGE PKWY STE 110
HENDERSON NV
89002-7906
US

V. Phone/Fax

Practice location:
  • Phone: 702-545-0808
  • Fax: 702-998-4220
Mailing address:
  • Phone: 702-545-0808
  • Fax: 702-998-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA P SHURTLEFF
Title or Position: PRESIDENT
Credential: MD
Phone: 702-545-0808