Healthcare Provider Details

I. General information

NPI: 1801115795
Provider Name (Legal Business Name): JANET WHEBLE PA-C LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 S FORT APACHE RD STE 120
LAS VEGAS NV
89148-3601
US

IV. Provider business mailing address

4162 E PATRICK LN
LAS VEGAS NV
89120-3905
US

V. Phone/Fax

Practice location:
  • Phone: 702-354-5712
  • Fax:
Mailing address:
  • Phone: 702-354-5712
  • Fax: 702-456-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number412
License Number StateNV

VIII. Authorized Official

Name: JANET R. WHEBLE
Title or Position: PRESIDENT
Credential: PA-C MPAS
Phone: 702-354-5712