Healthcare Provider Details

I. General information

NPI: 1285939819
Provider Name (Legal Business Name): MS. DESIREE JEAMON GARDNER-PEREIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 W CHARLESTON BLVD
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

3839 BLUE GULL ST
NORTH LAS VEGAS NV
89032-6601
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6092
  • Fax: 702-486-0411
Mailing address:
  • Phone: 702-286-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16564
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: