Healthcare Provider Details

I. General information

NPI: 1649209420
Provider Name (Legal Business Name): DANA FORTE D O LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 W CHEYENNE AVE
LAS VEGAS NV
89129-8932
US

IV. Provider business mailing address

9010 W CHEYENNE AVE
LAS VEGAS NV
89129-8932
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-8646
  • Fax: 702-240-0206
Mailing address:
  • Phone: 702-240-8646
  • Fax: 702-240-0206

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANA M FORTE
Title or Position: PRESIDENT
Credential: DO
Phone: 702-240-8646