Healthcare Provider Details

I. General information

NPI: 1427780030
Provider Name (Legal Business Name): SIRANUSH KHALADZHYAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 02/05/2024
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E FLAMINGO RD STE 201
LAS VEGAS NV
89119-5192
US

IV. Provider business mailing address

1452 W HORIZON RIDGE PKWY STE 566
HENDERSON NV
89012-4422
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-7831
  • Fax: 877-409-2014
Mailing address:
  • Phone: 702-800-7831
  • Fax: 877-409-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number855350
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: