Healthcare Provider Details

I. General information

NPI: 1710412622
Provider Name (Legal Business Name): KIMBERLY MARIE LENIHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 W SAHARA AVE STE C1
LAS VEGAS NV
89102-6059
US

IV. Provider business mailing address

3308 BIRCH TREE LN
LAS VEGAS NV
89117-3458
US

V. Phone/Fax

Practice location:
  • Phone: 702-445-7318
  • Fax:
Mailing address:
  • Phone: 702-445-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRSS-5411
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: