Healthcare Provider Details

I. General information

NPI: 1316368673
Provider Name (Legal Business Name): SOUTHERN NEVADA HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW LN STE 208
LAS VEGAS NV
89106-4363
US

IV. Provider business mailing address

400 SHADOW LN STE 208
LAS VEGAS NV
89106-4363
US

V. Phone/Fax

Practice location:
  • Phone: 702-759-0930
  • Fax:
Mailing address:
  • Phone: 702-759-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberRN23003
License Number StateNV

VIII. Authorized Official

Name: MS. EDITH C BURNS
Title or Position: RN CASE MANAGER
Credential: REGISTERED NURSE
Phone: 702-759-0930