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General NPI Number Information
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NPI Number | 1932648847
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES OF NEVADA LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 3483 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89169-3314
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Country | US
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Telephone | 702-487-7055
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Fax |
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Provider Business Mailing Address
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Address Line | 7021 SADDLE BACK PEAK ST
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City | LAS VEGAS
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State | NV
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Zip | 89166-7127
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Country | US
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Telephone | 702-328-7594
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Fax | 702-998-4052
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Authorized Official
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Title or Position | OWNER
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Name | CARA FANNING
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Credential | MD
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Telephone | 702-328-7594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NV
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State | NV
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