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NPI Code Detail

MEDICARE: NINA V NATION PA-C

MEDICARE: NINA V NATION PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA777NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255321774
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA V NATION PA-C
Provider Business Mailing Address
First Line : PO BOX 36310
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-6310
Country : US
Telephone Number : 702-382-1599
Fax Number : 702-240-4962
Provider Business Practice Location Address
First Line : 3425 CLIFF SHADOWS PKWY STE 250
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-5112
Country : US
Telephone Number : 702-382-1599
Fax Number : 702-240-4962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/31/2025

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