Healthcare Provider Details

I. General information

NPI: 1619867611
Provider Name (Legal Business Name): ANGELA SUE NIGHSWANDER RN, ASN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PILOT RD STE 250
LAS VEGAS NV
89119-3514
US

IV. Provider business mailing address

210 QUEST PARK ST APT 335
HENDERSON NV
89074-1614
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number889576
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: