Healthcare Provider Details

I. General information

NPI: 1801602693
Provider Name (Legal Business Name): PREMIER HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 W RUSSELL RD STE 10J
LAS VEGAS NV
89118-6243
US

IV. Provider business mailing address

4815 W RUSSELL RD STE 10J
LAS VEGAS NV
89118-6243
US

V. Phone/Fax

Practice location:
  • Phone: 702-637-2180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHAN BARILE
Title or Position: MANAGER
Credential:
Phone: 702-637-2180