MEDICARE: NOVA HEALTHCARE GROUP LLC

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	363LA2200X	Adult Health Nurse Practitioner	002927	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1548754690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA HEALTHCARE GROUP LLC

Provider Business Mailing Address
First Line	:	175 CROOKED PUTTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5228
Country	:	US
Telephone Number	:	702-268-8900
Fax Number	:	702-664-6729

Provider Business Practice Location Address
First Line	:	175 CROOKED PUTTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5228
Country	:	US
Telephone Number	:	702-268-8900
Fax Number	:	702-664-6729

Authorized Official
Title or Position	:	PROVIDER/ OWNER
Name	:	MS. ANNELEISA GAIL MCDONALD
Credential	:	APRN-BC
Telephone Number	:	702-268-8900

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	09/28/2022

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Directions to “NOVA HEALTHCARE GROUP LLC ” Practice Location

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