MEDICARE: NEVADA STATE HEALTH DIVISION/FAR NURSIN

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
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1518199645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA STATE HEALTH DIVISION/FAR NURSIN

Provider Business Mailing Address
First Line	:	4150 TECHNOLOGY WAY
Second Line	:	SUITE 101
City	:	CARSON CITY
State	:	NV
Zip	:	89706-2028
Country	:	US
Telephone Number	:	775-684-5900
Fax Number	:	775-684-3492

Provider Business Practice Location Address
First Line	:	34 LAKES BLVD
Second Line	:
City	:	DAYTON
State	:	NV
Zip	:	89403-8803
Country	:	US
Telephone Number	:	775-246-6211
Fax Number	:	775-246-6312

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES, FAR/
Name	:	MS. MARY E. WHERRY
Credential	:	RN, MS
Telephone Number	:	775-684-4018

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	06/10/2010

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