Healthcare Provider Details

I. General information

NPI: 1033243076
Provider Name (Legal Business Name): R DOMINIC NARDELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE 370
LAS VEGAS NV
89128-0485
US

IV. Provider business mailing address

1930 VILLAGE CENTER CIR STE 3-328
LAS VEGAS NV
89134-6238
US

V. Phone/Fax

Practice location:
  • Phone: 702-558-2111
  • Fax: 702-558-8333
Mailing address:
  • Phone: 702-558-2111
  • Fax: 702-558-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONALD DOMINIC NARDELL
Title or Position: PRESIDENT
Credential: MD
Phone: 702-558-2111