Healthcare Provider Details

I. General information

NPI: 1821858424
Provider Name (Legal Business Name): IRMA SUWANDUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 PLATA DEL SOL DR
LAS VEGAS NV
89121-6861
US

IV. Provider business mailing address

8342 TIBANA WAY
LAS VEGAS NV
89147-5210
US

V. Phone/Fax

Practice location:
  • Phone: 702-981-1484
  • Fax: 702-995-0242
Mailing address:
  • Phone: 702-235-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: