Healthcare Provider Details

I. General information

NPI: 1720792690
Provider Name (Legal Business Name): LAURA UNGER VICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

IV. Provider business mailing address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-6200
  • Fax:
Mailing address:
  • Phone: 702-483-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number857966
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number857966
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: