Healthcare Provider Details

I. General information

NPI: 1245905819
Provider Name (Legal Business Name): PAMELA MUKAMI NJIRU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2021
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MARYLAND PKWY STE 512
LAS VEGAS NV
89109-2427
US

IV. Provider business mailing address

284 E LAKE MEAD PKWY STE C # 261
HENDERSON NV
89015-6433
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-7700
  • Fax: 702-629-7800
Mailing address:
  • Phone: 702-685-7700
  • Fax: 702-629-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number845342
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number845342
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: