Healthcare Provider Details

I. General information

NPI: 1972311538
Provider Name (Legal Business Name): NICHOLAS ESTELLE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E LAKE MEAD BLVD STE 300
NORTH LAS VEGAS NV
89030-7193
US

IV. Provider business mailing address

5016 KASLO AVE
LAS VEGAS NV
89139-7720
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-4150
  • Fax:
Mailing address:
  • Phone: 239-738-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number878557
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: