Healthcare Provider Details

I. General information

NPI: 1679691901
Provider Name (Legal Business Name): ELIZABETH E FILDES EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 W CHARLESTON BLVD A- 172
LAS VEGAS NV
89146-1139
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD 215
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-0684
  • Fax: 702-877-2105
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN29092
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN29092
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: