Healthcare Provider Details

I. General information

NPI: 1598274151
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL GROUP NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 S EASTERN AVE STE 209
HENDERSON NV
89052-3908
US

IV. Provider business mailing address

2200 PASEO VERDE PKWY STE 260
HENDERSON NV
89052-2703
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-5801
  • Fax:
Mailing address:
  • Phone: 702-616-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WALKER MELISSA
Title or Position: CFO
Credential:
Phone: 702-616-5507