Healthcare Provider Details

I. General information

NPI: 1104312180
Provider Name (Legal Business Name): JAIMIE EVA WARDINGER MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

9529 SIERRA SUMMIT AVE
LAS VEGAS NV
89134-0113
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-5000
  • Fax:
Mailing address:
  • Phone: 586-224-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD475719
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25868
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: