Healthcare Provider Details

I. General information

NPI: 1902532336
Provider Name (Legal Business Name): PRIORITY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3440 W CHEYENNE AVE STE 100
NORTH LAS VEGAS NV
89032-8221
US

IV. Provider business mailing address

10241 ANGELS LOFT ST
LAS VEGAS NV
89131-1541
US

V. Phone/Fax

Practice location:
  • Phone: 702-529-0059
  • Fax: 702-529-0098
Mailing address:
  • Phone: 702-529-0059
  • Fax: 702-529-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS PENNA
Title or Position: OWNER
Credential:
Phone: 702-529-0059