Healthcare Provider Details

I. General information

NPI: 1932648847
Provider Name (Legal Business Name): INFECTIOUS DISEASES OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 E FLAMINGO RD STE 216
LAS VEGAS NV
89119-5155
US

IV. Provider business mailing address

7021 SADDLE BACK PEAK ST
LAS VEGAS NV
89166-7127
US

V. Phone/Fax

Practice location:
  • Phone: 702-991-2999
  • Fax: 702-710-0418
Mailing address:
  • Phone: 702-991-2999
  • Fax: 702-710-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNV

VIII. Authorized Official

Name: CARA FANNING
Title or Position: OWNER
Credential: MD
Phone: 702-328-7594