Healthcare Provider Details

I. General information

NPI: 1225880883
Provider Name (Legal Business Name): CHADWICK NIERVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S CIMARRON RD STE 100
LAS VEGAS NV
89113-2181
US

IV. Provider business mailing address

6655 S CIMARRON RD STE 100
LAS VEGAS NV
89113-2181
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-3561
  • Fax:
Mailing address:
  • Phone: 702-853-3564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL4692
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: