Basic Information
Provider Information
NPI: 1174164404
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HORVATH
FirstName: DENISE
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 N STEPHANIE ST STE 300
Address2:  
City: HENDERSON
State: NV
PostalCode: 890146692
CountryCode: US
TelephoneNumber: 7029523350
FaxNumber: 7029523364
Practice Location
Address1: 3150 N TENAYA WAY STE 125
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891280484
CountryCode: US
TelephoneNumber: 7028690855
FaxNumber: 7028690859
Other Information
ProviderEnumerationDate: 10/08/2019
LastUpdateDate: 10/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X824494NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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