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General NPI Number Information
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NPI Number | 1902532336
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Entity Type | Organization
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Legal Business Name | PRIORITY HEALTHCARE LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 3440 W CHEYENNE AVE STE 100
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-8221
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Country | US
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Telephone | 702-529-0059
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Fax | 702-529-0098
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Provider Business Mailing Address
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Address Line | 10241 ANGELS LOFT ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-1541
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Country | US
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Telephone | 702-529-0059
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Fax | 702-529-0098
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS PENNA
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Credential |
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Telephone | 702-529-0059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SC2300X
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Taxonomy Name | Chronic Care Clinical Nurse Specialist
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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