Healthcare Provider Details

I. General information

NPI: 1992713671
Provider Name (Legal Business Name): WILLIAM P EMMERLING FNP C ED D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 W SUNSET RD STE 120
HENDERSON NV
89014-6635
US

IV. Provider business mailing address

1490 W SUNSET RD STE 120
HENDERSON NV
89014-6635
US

V. Phone/Fax

Practice location:
  • Phone: 855-955-5428
  • Fax: 844-389-0835
Mailing address:
  • Phone: 630-386-5832
  • Fax: 844-389-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN000660
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberAPN000660
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP4183
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN000660
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: