| NPI | 1326800939 |
|---|---|
| Doing Business As | PROVISION CREATED HEALTHCARE |
| Entity Type | Organization |
| Authorized Contact | PHILLISHA ANDREA THOMPSON Nurse Practitioner 702-665-8111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-01-31 |