Healthcare Provider Details

I. General information

NPI: 1629200746
Provider Name (Legal Business Name): NEVADA STATE HEALTH DIVISION/FAR NURSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E HASKELL ST
WINNEMUCCA NV
89445-3247
US

IV. Provider business mailing address

4150 TECHNOLOGY WAY SUITE 101
CARSON CITY NV
89706-2028
US

V. Phone/Fax

Practice location:
  • Phone: 775-623-6575
  • Fax: 775-623-6576
Mailing address:
  • Phone: 775-684-5900
  • Fax: 775-684-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY E. WHERRY
Title or Position: DIRECTOR OF CLINICAL SERVICES, FAR/
Credential: RN, MS
Phone: 775-684-4018