Basic Information
| Provider Information | |||||||||
| NPI: | 1710504691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 731 BOOTED EAGLE ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890158517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526727553 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | BOULDER CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890052213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026988342 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 830134 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.