Healthcare Provider Details

I. General information

NPI: 1326474818
Provider Name (Legal Business Name): UNIVERSITY OF NEVADA LAS VEGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S MARYLAND PKWY
LAS VEGAS NV
89154-9900
US

IV. Provider business mailing address

4505 S MARYLAND PKWY
LAS VEGAS NV
89154-9900
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-3370
  • Fax: 702-895-4316
Mailing address:
  • Phone: 702-895-3370
  • Fax: 702-895-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY UNDERWOOD
Title or Position: DIRECTOR
Credential:
Phone: 702-895-3370