Healthcare Provider Details

I. General information

NPI: 1366532434
Provider Name (Legal Business Name): TIKVA DARVISH BUTLER RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 E. DESERT INN ROAD
LAS VEGAS NV
89121
US

IV. Provider business mailing address

8906 SPANISH RIDGE AVE SUITE 202
LAS VEGAS NV
89148-1304
US

V. Phone/Fax

Practice location:
  • Phone: 702-796-9997
  • Fax: 702-796-1440
Mailing address:
  • Phone: 702-330-3102
  • Fax: 702-912-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number00106
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: