=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497722524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | USHA KIRAN NUTHI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2006
-----------------------------------------------------
Last Update Date | 05/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2385 E PRATER WAY SUITE 205
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89434-9629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-356-4888
-----------------------------------------------------
Fax | 775-356-4890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3046
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19355-0746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-356-4888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 00022841
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 15593
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------