Healthcare Provider Details

I. General information

NPI: 1760995393
Provider Name (Legal Business Name): TANYA AIKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 S FORT APACHE RD
LAS VEGAS NV
89148-3600
US

IV. Provider business mailing address

1672 FLORES LN
HENDERSON NV
89012-3604
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-2273
  • Fax: 702-475-4003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN35693
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: