Basic Information
| Provider Information | |||||||||
| NPI: | 1598274151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGNITY HEALTH MEDICAL GROUP NEVADA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 PASEO VERDE PKWY STE 260 | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890522703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10001 S EASTERN AVE STE 209 | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2017 | ||||||||
| LastUpdateDate: | 09/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | MELISSA | ||||||||
| AuthorizedOfficialFirstName: | WALKER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7026165507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 2080P0205X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.