Healthcare Provider Details

I. General information

NPI: 1285740035
Provider Name (Legal Business Name): PYRAMID LAKE PAIUTE TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HIGHWAY 446
NIXON NV
89424
US

IV. Provider business mailing address

PO BOX 227
NIXON NV
89424
US

V. Phone/Fax

Practice location:
  • Phone: 775-574-1018
  • Fax: 775-574-1114
Mailing address:
  • Phone: 775-574-1018
  • Fax: 775-574-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNV

VIII. Authorized Official

Name: MRS. DAWNA LEE BROWN
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 775-574-1018