Healthcare Provider Details

I. General information

NPI: 1306351952
Provider Name (Legal Business Name): ELIZABETH CARROLL WILKES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 PINTO LN FL 3
LAS VEGAS NV
89106-4195
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-2828
  • Fax:
Mailing address:
  • Phone: 702-780-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002725
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: