Basic Information
| Provider Information | |||||||||
| NPI: | 1144769035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUREEKATTIL | ||||||||
| FirstName: | SHEEBA | ||||||||
| MiddleName: | SAJI | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2345 E PRATER WAY STE 207 | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894349634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753564067 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5380 S RAINBOW BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891181878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7253338465 | ||||||||
| FaxNumber: | 7253338466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2017 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN002423 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1144769035 | 05 | NV | MEDICAID |