Healthcare Provider Details

I. General information

NPI: 1639661549
Provider Name (Legal Business Name): MOHAMED ALHAJI KAMARA REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR STE 9
LAS VEGAS NV
89120-4429
US

IV. Provider business mailing address

3450 TANTO CIR
LAS VEGAS NV
89121-5047
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-0920
  • Fax:
Mailing address:
  • Phone: 702-487-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN54830
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: