Healthcare Provider Details

I. General information

NPI: 1891141552
Provider Name (Legal Business Name): JONA STEAD AGNP, APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/10/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N NELLIS BLVD
LAS VEGAS NV
89110-5382
US

IV. Provider business mailing address

650 N NELLIS BLVD
LAS VEGAS NV
89110-5382
US

V. Phone/Fax

Practice location:
  • Phone: 702-790-8000
  • Fax:
Mailing address:
  • Phone: 702-790-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00636300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00636300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number839722
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: