Healthcare Provider Details

I. General information

NPI: 1386062628
Provider Name (Legal Business Name): NEVADA SURGERY AND CANCER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 S. JONES BLVD
LAS VEGAS NV
89118
US

IV. Provider business mailing address

6020 S. JONES BLVD
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-6467
  • Fax: 702-733-1619
Mailing address:
  • Phone: 702-739-6467
  • Fax: 702-733-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE WISHNIEV
Title or Position: OWNER
Credential: MD
Phone: 702-739-6467