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General NPI Number Information
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NPI Number | 1720302680
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Entity Type | Individual
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Provider Name | KRISTINE S HERLEVI PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 2839 ST ROSE PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89052-4806
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Country | US
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Telephone | 702-837-8988
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Fax | 702-990-5269
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Provider Business Mailing Address
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Address Line | 470 E 3900 S STE 200
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-2332
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Country | US
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Telephone | 801-747-2800
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Fax | 801-747-5222
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8322950-1206
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1211
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License Number State | NV
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