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NPI Code Detail

MEDICARE: NKEMDILIM N NWOFOR APRN

MEDICARE: NKEMDILIM N NWOFOR APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner863578NV

General Provider Information

NPI Number : 1588361141
Entity Type Code : Individual
Provider Name (Legal Business Name) : NKEMDILIM N NWOFOR APRN
Provider Business Mailing Address
First Line : 8215 S EASTERN AVE STE 109
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2515
Country : US
Telephone Number : 775-406-8643
Fax Number : 702-442-7329
Provider Business Practice Location Address
First Line : 8215 S EASTERN AVE STE 109
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2515
Country : US
Telephone Number : 775-406-8643
Fax Number : 702-442-7329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2023
Last Update Date : 11/06/2024

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Directions to “ NKEMDILIM N NWOFOR APRN” Practice Location

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