Healthcare Provider Details

I. General information

NPI: 1821121310
Provider Name (Legal Business Name): UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MILL ST 102
RENO NV
89502-1442
US

IV. Provider business mailing address

PO BOX 29506
LAS VEGAS NV
89126-9506
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-2731
  • Fax: 775-322-2790
Mailing address:
  • Phone: 702-968-4371
  • Fax: 702-671-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000640
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number000640
License Number StateNV

VIII. Authorized Official

Name: DR. ELISSA J. PALMER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-992-6888