Healthcare Provider Details

I. General information

NPI: 1790129062
Provider Name (Legal Business Name): ZELLUYAH GAITHO APN GNP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10161 PARK RUN DR STE 150
LAS VEGAS NV
89145-8872
US

IV. Provider business mailing address

10161 PARK RUN DR STE 150
LAS VEGAS NV
89145-8872
US

V. Phone/Fax

Practice location:
  • Phone: 702-569-5410
  • Fax:
Mailing address:
  • Phone: 702-569-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001242
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN001242
License Number StateNV

VIII. Authorized Official

Name: ZELLUYAH GAITHO
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 702-569-5410