Healthcare Provider Details

I. General information

NPI: 1528126471
Provider Name (Legal Business Name): KRISTEN BROSIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 SIENA HEIGHTS DR STE 1100
HENDERSON NV
89052-4161
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-1880
  • Fax:
Mailing address:
  • Phone: 702-383-6210
  • Fax: 702-435-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1024
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: