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NPI Code Detail

MEDICARE: PROF. NELLADEE STREET F.N.P.

MEDICARE: PROF. NELLADEE STREET F.N.P.
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
1207Q00000XFamily Medicine PhysicianAPN00314NV

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 : 1588646665
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. NELLADEE STREET F.N.P.
Provider Business Mailing Address
First Line : 1301 BERTHA HOWE AVE
Second Line : SUITE 1
City : MESQUITE
State : NV
Zip : 89027-7502
Country : US
Telephone Number : 702-346-0800
Fax Number : 702-346-0801
Provider Business Practice Location Address
First Line : 1301 BERTHA HOWE AVE
Second Line : SUITE 1
City : MESQUITE
State : NV
Zip : 89027-7502
Country : US
Telephone Number : 702-346-0800
Fax Number : 702-346-0801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 07/09/2007

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