Healthcare Provider Details

I. General information

NPI: 1831390756
Provider Name (Legal Business Name): NORTHERN NEVADA WOMEN'S GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2ND ST STE 408
RENO NV
89502-1197
US

IV. Provider business mailing address

1500 E 2ND ST STE 408
RENO NV
89502-1197
US

V. Phone/Fax

Practice location:
  • Phone: 775-829-9500
  • Fax: 775-829-1234
Mailing address:
  • Phone: 775-829-9500
  • Fax: 775-829-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8903
License Number StateNV

VIII. Authorized Official

Name: MRS. MICAH RENEE WRIGHT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 775-829-9500