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NPI Code Detail

MEDICARE: KAZAKK LLC

MEDICARE: KAZAKK 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
1363LA2100XAcute Care Nurse Practitioner
2363LG0600XGerontology Nurse Practitioner

General Provider Information

NPI Number : 1598203978
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAZAKK LLC
Provider Business Mailing Address
First Line : 7866 W SAHARA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1944
Country : US
Telephone Number : 702-277-6724
Fax Number : 888-291-9747
Provider Business Practice Location Address
First Line : 7866 W SAHARA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1944
Country : US
Telephone Number : 702-277-6724
Fax Number : 888-291-9747
Authorized Official
Title or Position : PRESIDENT
Name : KELLI GRIMLIE
Credential :
Telephone Number : 702-277-6724
Provider Enumeration Date : 02/06/2017
Last Update Date : 02/06/2017

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Directions to “KAZAKK LLC ” Practice Location

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