Healthcare Provider Details

I. General information

NPI: 1760772453
Provider Name (Legal Business Name): DR. PEACE NNENNA IBEKWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

IV. Provider business mailing address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-7810
  • Fax:
Mailing address:
  • Phone: 702-961-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number19133
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016-01484
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: