Healthcare Provider Details

I. General information

NPI: 1417193665
Provider Name (Legal Business Name): EMMANUEL NWAPA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 INDUSTRIAL RD STE 110
LAS VEGAS NV
89102-2685
US

IV. Provider business mailing address

1800 INDUSTRIAL RD STE 110
LAS VEGAS NV
89102-2685
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-8200
  • Fax:
Mailing address:
  • Phone: 702-380-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number10730
License Number StateNV

VIII. Authorized Official

Name: EMMANUEL NWAPA
Title or Position: PRESIDENT
Credential: MD
Phone: 702-380-8200