Healthcare Provider Details

I. General information

NPI: 1629372305
Provider Name (Legal Business Name): LEAH B HENRY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH B DAVIS

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 LAS VEGAS BLVD S
HENDERSON NV
89044-9506
US

IV. Provider business mailing address

PO BOX 230181
LAS VEGAS NV
89105-0181
US

V. Phone/Fax

Practice location:
  • Phone: 702-837-1265
  • Fax: 702-837-1706
Mailing address:
  • Phone: 702-837-1265
  • Fax: 702-837-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN001230
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: