MEDICARE: STEPHANIE A WISHNEV MD LTD

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	208C00000X	Colon & Rectal Surgery Physician

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	:	1891735304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE A WISHNEV MD LTD

Provider Business Mailing Address
First Line	:	6020 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2619
Country	:	US
Telephone Number	:	702-739-6467
Fax Number	:	702-733-1689

Provider Business Practice Location Address
First Line	:	6020 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	702-739-6467
Fax Number	:	702-733-1689

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE A WISHNEV
Credential	:	MD
Telephone Number	:	702-739-6467

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	01/02/2026

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