Healthcare Provider Details

I. General information

NPI: 1568427334
Provider Name (Legal Business Name): JESSE A VINER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N ARLINGTON AVE
RENO NV
89503-4723
US

IV. Provider business mailing address

555 N ARLINGTON AVE
RENO NV
89503-4723
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-3040
  • Fax: 775-348-3051
Mailing address:
  • Phone: 775-786-3040
  • Fax: 775-786-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2231
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: