Healthcare Provider Details

I. General information

NPI: 1275387383
Provider Name (Legal Business Name): NATHANIEL BARRY NEASE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

IV. Provider business mailing address

10828 WINDROSE POINT AVE
LAS VEGAS NV
89144-5425
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-6750
  • Fax:
Mailing address:
  • Phone: 970-389-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN57363
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number883061
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: