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General NPI Number Information
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NPI Number | 1861207599
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Entity Type | Organization
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Legal Business Name | ELITE CARE PROVIDERS LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 4567 WEITZMAN PL
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City | LAS VEGAS
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State | NV
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Zip | 89141
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Country | US
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Telephone | 725-755-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 4567 WEITZMAN PL
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City | LAS VEGAS
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State | NV
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Zip | 89141-6036
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Country | US
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Telephone | 510-378-9718
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | KATRINA BIDWELL
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Credential | APRN
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Telephone | 510-378-9718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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