Healthcare Provider Details

I. General information

NPI: 1487680815
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: 06/25/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W. CHARLESTON BLVD. SUITE 210
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

1001 SHADOW LANE MS 7413
LAS VEGAS NV
89106-4124
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5175
  • Fax: 702-474-9617
Mailing address:
  • Phone: 702-774-2400
  • Fax: 702-774-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURIE ANN EVANS
Title or Position: DIRECTOR OF CLINICAL BUSINESS SVCS.
Credential: MBA
Phone: 702-774-2819