Healthcare Provider Details

I. General information

NPI: 1255177473
Provider Name (Legal Business Name): HLS PRACTITIONER PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 W AGATE AVE
LAS VEGAS NV
89139-7541
US

IV. Provider business mailing address

4840 W AGATE AVE
LAS VEGAS NV
89139-7541
US

V. Phone/Fax

Practice location:
  • Phone: 702-748-3915
  • Fax:
Mailing address:
  • Phone: 702-748-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. HANA LEIGH SWARTZENTRUBER
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 702-748-3915