Healthcare Provider Details

I. General information

NPI: 1396828430
Provider Name (Legal Business Name): FAITH ALVERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E. LAKE MEAD BLVD
LAS VEGAS NV
89030
US

IV. Provider business mailing address

BOX 647
WISHEK ND
58495-0647
US

V. Phone/Fax

Practice location:
  • Phone: 800-815-8377
  • Fax:
Mailing address:
  • Phone: 701-452-2364
  • Fax: 701-452-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA845
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: