Healthcare Provider Details

I. General information

NPI: 1164076873
Provider Name (Legal Business Name): MONTERAY SELLERS DEANDRE MCGEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W OWENS AVE
LAS VEGAS NV
89106-2516
US

IV. Provider business mailing address

916 W OWENS AVE
LAS VEGAS NV
89106-2516
US

V. Phone/Fax

Practice location:
  • Phone: 702-846-6622
  • Fax: 702-685-9014
Mailing address:
  • Phone: 702-846-6622
  • Fax: 702-685-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEANDRE MCGEE
Title or Position: OWNER
Credential:
Phone: 702-846-6622