Healthcare Provider Details

I. General information

NPI: 1316118946
Provider Name (Legal Business Name): PAMELA E. NETUSCHIL M.D. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 S MCCARRAN BLVD SUITE A
RENO NV
89509-6160
US

IV. Provider business mailing address

6580 S MCCARRAN BLVD SUITE A
RENO NV
89509-6160
US

V. Phone/Fax

Practice location:
  • Phone: 775-432-1343
  • Fax: 775-324-0858
Mailing address:
  • Phone: 775-432-1343
  • Fax: 775-324-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8595
License Number StateNV

VIII. Authorized Official

Name: PEGGY J PAYNE
Title or Position: BILLING
Credential:
Phone: 775-240-3123