Healthcare Provider Details

I. General information

NPI: 1033206339
Provider Name (Legal Business Name): NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W 5TH ST SUITE 12A
RENO NV
89503-4407
US

IV. Provider business mailing address

580 W 5TH ST SUITE 12A
RENO NV
89503-4407
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-1306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberPH01763
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHARON CHAMBERLAIN
Title or Position: CEO
Credential:
Phone: 775-786-4673