Healthcare Provider Details

I. General information

NPI: 1114871274
Provider Name (Legal Business Name): VAHID MORADI GHEISVANDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VAN MORADI NP

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10760 MERIDIAN MILLS RD
HENDERSON NV
89052-8686
US

IV. Provider business mailing address

10760 MERIDIAN MILLS RD
HENDERSON NV
89052-8686
US

V. Phone/Fax

Practice location:
  • Phone: 702-606-1272
  • Fax:
Mailing address:
  • Phone: 702-606-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number899073
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number899073
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: