Healthcare Provider Details

I. General information

NPI: 1720813504
Provider Name (Legal Business Name): VIVIAN HEALTHCARE LV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 PAINTED DAISY AVE
HENDERSON NV
89074-8098
US

IV. Provider business mailing address

1048 PAINTED DAISY AVE
HENDERSON NV
89074-8098
US

V. Phone/Fax

Practice location:
  • Phone: 952-594-5232
  • Fax:
Mailing address:
  • Phone: 952-594-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY MARIE HANEN-SCHWINHAMER
Title or Position: APRN
Credential: APRN
Phone: 952-594-5232