Healthcare Provider Details

I. General information

NPI: 1104861533
Provider Name (Legal Business Name): SEAN NEIL COVEY C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BERTHA HOWE AVE
MESQUITE NV
89027-7500
US

IV. Provider business mailing address

1299 BERTHA HOWE AVE
MESQUITE NV
89027-7500
US

V. Phone/Fax

Practice location:
  • Phone: 702-345-4303
  • Fax: 702-345-4389
Mailing address:
  • Phone: 702-345-4303
  • Fax: 702-345-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number727123
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA000337
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: