Healthcare Provider Details

I. General information

NPI: 1093770596
Provider Name (Legal Business Name): STEVEN M SERTICH C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

174 ULTRA DR
HENDERSON NV
89074-8331
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2392
  • Fax:
Mailing address:
  • Phone: 702-236-0700
  • Fax: 702-263-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number109
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: