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General NPI Number Information
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NPI Number | 1255416491
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Entity Type | Organization
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Legal Business Name | STATE OF NEVADA
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 1005 MAIN STREET
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City | PANACA
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State | NV
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Zip | 89042-0000
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Country | US
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Telephone | 775-726-3123
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Fax |
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Provider Business Mailing Address
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Address Line | 727 FAIRVIEW DR STE A
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City | CARSON CITY
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State | NV
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Zip | 89701-5493
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Country | US
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Telephone | 775-684-5031
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Fax | 775-687-1181
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Authorized Official
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Title or Position | CHNIII
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Name | TAMMY RITTER
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Credential | RN
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Telephone | 775-684-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | NV
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