Healthcare Provider Details

I. General information

NPI: 1982921037
Provider Name (Legal Business Name): MARIA TERESA DEMAVIVAS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W CHARLESTON BLVD SUITE 202
LAS VEGAS NV
89102-1900
US

IV. Provider business mailing address

3100 W CHARLESTON BLVD SUITE 202
LAS VEGAS NV
89102-1900
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-9511
  • Fax: 702-877-6711
Mailing address:
  • Phone: 702-877-9511
  • Fax: 702-877-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001170
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: