Healthcare Provider Details

I. General information

NPI: 1083347033
Provider Name (Legal Business Name): GEMECHIS N/A PETROS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 S MARYLAND PKWY
LAS VEGAS NV
89109-2412
US

IV. Provider business mailing address

3247 S MARYLAND PKWY
LAS VEGAS NV
89109-2412
US

V. Phone/Fax

Practice location:
  • Phone: 702-776-3500
  • Fax:
Mailing address:
  • Phone: 702-776-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number857063
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: