Healthcare Provider Details

I. General information

NPI: 1841982527
Provider Name (Legal Business Name): ELIZEBETH MATHEW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 W HORIZON RIDGE PKWY STE 120
HENDERSON NV
89052-2899
US

IV. Provider business mailing address

3097 E WARM SPRINGS RD STE 400
LAS VEGAS NV
89120-3757
US

V. Phone/Fax

Practice location:
  • Phone: 702-790-2211
  • Fax: 702-790-2316
Mailing address:
  • Phone: 702-790-2211
  • Fax: 702-790-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number857580
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: