Healthcare Provider Details

I. General information

NPI: 1346796638
Provider Name (Legal Business Name): PATRICIA LEDFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 W CHARLESTON BLVD BUILDING 17
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

6525 CONVINTO STREET
LAS VEGAS NV
89131-3152
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-9696
  • Fax: 702-486-5712
Mailing address:
  • Phone: 702-354-6554
  • Fax: 702-486-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN21672
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN21672
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: