Healthcare Provider Details

I. General information

NPI: 1073115614
Provider Name (Legal Business Name): LEA DIOLA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S EASTERN AVE STE 1
LAS VEGAS NV
89119-7851
US

IV. Provider business mailing address

6040 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5613
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-5319
  • Fax: 702-442-1494
Mailing address:
  • Phone: 702-476-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN191089
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN95778
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number842695
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: