MEDICARE: DR. NICOLE THEUVENET M.D.

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	2084N0400X	Neurology Physician	7846	NV

General Provider Information

NPI Number	:	1972662393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE THEUVENET M.D.

Provider Business Mailing Address
First Line	:	8275 S EASTERN AVE STE 253
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2505
Country	:	US
Telephone Number	:	702-933-0971
Fax Number	:	702-933-0974

Provider Business Practice Location Address
First Line	:	8275 S EASTERN AVE STE 253
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2505
Country	:	US
Telephone Number	:	702-933-0971
Fax Number	:	702-933-0974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	04/02/2025

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