Healthcare Provider Details

I. General information

NPI: 1518781186
Provider Name (Legal Business Name): CAROLYN HANUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3087 E WARM SPRINGS RD STE 300
LAS VEGAS NV
89120-3754
US

IV. Provider business mailing address

957 WILLIAMTOWN AVE
NORTH LAS VEGAS NV
89084-4052
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-1260
  • Fax:
Mailing address:
  • Phone: 402-289-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number5214
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: