Healthcare Provider Details

I. General information

NPI: 1689233652
Provider Name (Legal Business Name): SIOBHAN ASSOON-BROADY DNP-PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MARYLAND PKWY STE 608
LAS VEGAS NV
89109-2428
US

IV. Provider business mailing address

3201 S MARYLAND PKWY STE 608
LAS VEGAS NV
89109-2428
US

V. Phone/Fax

Practice location:
  • Phone: 702-457-5437
  • Fax: 702-464-5801
Mailing address:
  • Phone: 702-457-5437
  • Fax: 702-464-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-CNP817771
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: