Basic Information
Provider Information | |||||||||
NPI: | 1023407483 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOAKYE-WENZEL | ||||||||
FirstName: | HEATHER | ||||||||
MiddleName: | NICOLE AKYEA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BOAKYE | ||||||||
OtherFirstName: | HEATHER | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3016 W CHARLESTON BLVD STE 100 | ||||||||
Address2: |   | ||||||||
City: | LAS VEGAS | ||||||||
State: | NV | ||||||||
PostalCode: | 891021973 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7026715070 | ||||||||
FaxNumber: | 7028954014 | ||||||||
Practice Location | |||||||||
Address1: | 1707 W CHARLESTON BLVD STE 270 | ||||||||
Address2: |   | ||||||||
City: | LAS VEGAS | ||||||||
State: | NV | ||||||||
PostalCode: | 891022351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7024854400 | ||||||||
FaxNumber: | 7024854405 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2015 | ||||||||
LastUpdateDate: | 06/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50505 | AZ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 00 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 50505 | AZ | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RP1001X | 20142 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.