Basic Information
Provider Information
NPI: 1427765726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TERBISH
FirstName: NERGUI
MiddleName: NIKKI
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3501 RAGING BULL ST
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891297203
CountryCode: US
TelephoneNumber: 7026063790
FaxNumber:  
Practice Location
Address1: 1800 W CHARLESTON BLVD
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891022329
CountryCode: US
TelephoneNumber: 7023832000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/04/2022
LastUpdateDate: 11/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X859408NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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