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General NPI Number Information
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NPI Number | 1083147318
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Entity Type | Individual
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Provider Name | NELLY PORTMAN CHOW D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 3150 N TENAYA WAY STE 260
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City | LAS VEGAS
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State | NV
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Zip | 89128-0459
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Country | US
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Telephone | 702-962-5920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100744
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City | ATLANTA
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State | GA
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Zip | 30384-0744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DO3749
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | DO3749
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License Number State | NV
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