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General NPI Number Information
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NPI Number | 1811871668
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Entity Type | Individual
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Provider Name | THERESA PEAHOTA LPN
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 3161 E WARM SPRINGS RD STE 400
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City | LAS VEGAS
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State | NV
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Zip | 89120-3144
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Country | US
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Telephone | 702-463-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 8107 HAYWOOD ESTATE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89113-3681
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Country | US
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Telephone | 856-430-7966
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 838169
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License Number State | NV
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