Healthcare Provider Details

I. General information

NPI: 1891735304
Provider Name (Legal Business Name): STEPHANIE WISHNEV MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 S JONES BLVD
LAS VEGAS NV
89118
US

IV. Provider business mailing address

6020 S JONES BLVD
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-6467
  • Fax: 702-733-1689
Mailing address:
  • Phone: 702-739-6467
  • Fax: 702-733-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A WISHNEV
Title or Position: OWNER
Credential: MD
Phone: 702-739-6467