Healthcare Provider Details

I. General information

NPI: 1518169200
Provider Name (Legal Business Name): BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 W CHARLESTON BLVD STE A500
LAS VEGAS NV
89146-1168
US

IV. Provider business mailing address

6375 W CHARLESTON BLVD STE A500
LAS VEGAS NV
89146-1168
US

V. Phone/Fax

Practice location:
  • Phone: 702-651-5514
  • Fax: 702-651-7383
Mailing address:
  • Phone: 702-651-5514
  • Fax: 702-651-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA L. MARION
Title or Position: CLINICAL SERVICES MANAGER
Credential:
Phone: 702-651-5514